Mehmet Oz

The final 2027 rate announcement raised the net payment update from 0.09 percent to 2.48 percent, about 4.98 percent once expected risk-score growth is counted, mainly by updating the effective growth rate with newer fee-for-service data. Plan stocks rallied, but the update still trailed the 5.06 percent of 2026 and medical-cost trends insurers said were running near 7 percent.

The contract-year 2027 rule dropped the planned health-equity reward in favour of the historical reward factor, removed a set of star measures including call-center tests and added a depression screening measure, codified the Inflation Reduction Act's Part D redesign, and eased marketing rules such as the 48-hour scope-of-appointment wait, effective October 1, 2026. CMS declined to finalise several beneficiary-protection proposals from the Biden era.

CMS proposed a net average increase of just 0.09 percent, about $700 million, for 2027, its smallest in years, citing the star ratings, risk-adjustment trends and the continued phase-in of the 2024 risk model. Insurers and Wall Street read the notice as confirmation that 2027 benefits and footprints would shrink further.

Previewing the 2026 landscape, CMS said plans' own bids projected enrollment of 34 million, down from 34.9 million and from 50 percent of Medicare to about 48 percent, though the agency expected actual enrollment to hold up better. Average MA premiums were projected to fall from $16.40 to $14.00 a month, with 99 percent of beneficiaries still having access to a plan.

At an HHS roundtable, Aetna, Humana, UnitedHealthcare, Elevance, Centene, Cigna, Kaiser Permanente, the Blues and AHIP committed to six voluntary reforms across Medicare Advantage, Medicaid managed care and commercial plans: fewer services subject to prior authorization in 2026, real-time electronic approvals and honouring other insurers' decisions by 2027. A year later, KFF Health News found insurers hedging on the promises.

Administrator Mehmet Oz announced that Risk Adjustment Data Validation audits would cover all roughly 550 MA contracts annually instead of about 60, with coders expanded from 40 to about 2,000 and the backlog of payment years 2018 to 2024 to be completed by early 2026. CMS cited estimates of up to $17 billion a year in overpayments from unsupported diagnoses.

Two months into the Trump administration, CMS finalized the 2026 rate announcement with a net payment increase of 5.06 percent, more than double the 2.23 percent the Biden administration had proposed in January, largely by using more recent claims data. It followed the April 4 final rule that dropped Biden-era proposals such as covering anti-obesity drugs.