CMS Updates to MA and Part D for CY 2026

 

The Friday Five for April 25, 2025:

• Dr. Oz shares MAHA vision as CMS admin
• CY 2026 Part D Coverage Cost Breakdown
• CY 2026 Selected Drug Subsidy Cost Breakdown
• Provisions Not Finalized in 2026 MA and Part D Final Rule
• Impact of Non-Finalized Provisions on Agents

 

Dr. Oz shares MAHA vision as CMS admin:

Simmons-Duffin, Selena. “5 Things to Know as Dr. Oz Prepares to Lead Medicare and Medicaid.” NPR.Org, NPR, 3 Apr. 2025, www.npr.org/sections/shots-health-news/2025/03/25/g-s1-55766/dr-mehmet-oz-medicare-medicaid-cms-trump.

“Dr. Mehmet Oz Shares Vision for CMS.” CMS.Gov, Centers for Medicare & Medicaid Services, 25 Apr. 2025, www.cms.gov/newsroom/press-releases/dr-mehmet-oz-shares-vision-cms.

Olsen, Emily. “Dr. Oz Sworn in as CMS Administrator.” Healthcaredive.Com, Healthcare Dive, 21 Apr. 2025, www.healthcaredive.com/news/dr-mehmet-oz-sworn-in-cms-administrator/745880/.

 

CY 2026 Part D Coverage Cost Breakdown:

“Final CY 2026 Part D Redesign Program Instructions.” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/newsroom/fact-sheets/final-cy-2026-part-d-redesign-program-instructions. Accessed 23 Apr. 2025.

“Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly.” Federalregister.Gov, Federal Register, 15 Apr. 2025, www.federalregister.gov/documents/2025/04/15/2025-06008/medicare-and-medicaid-programs-contract-year-2026-policy-and-technical-changes-to-the-medicare.

 

CY 2026 Selected Drug Subsidy Cost Breakdown:

John, Stephnie A., and Abdie Santiago. “The IRA in 2025: The Future of Medicare Part D.” Mintz.Com, Mintz, 13 Feb. 2025, www.mintz.com/insights-center/viewpoints/2146/2025-02-13-ira-2025-future-medicare-part-d.

“Medicare Prescription Drug Benefit Manual – Chapter 5.” Cms.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/files/document/chapter-5-benefits-and-beneficiary-protection-v92011.pdf. Accessed 23 Apr. 2025.

“Factsheet: Medicare Drug Price Negotiation Program.” Cms.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf. Accessed 23 Apr. 2025.

 

Provisions Not Finalized in 2026 MA and Part D Final Rule:

“Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly (CMS-4208-F).” CMS.Gov, Centers for Medicare & Medicaid Services, www.cms.gov/newsroom/fact-sheets/contract-year-2026-policy-and-technical-changes-medicare-advantage-program-medicare-prescription-final. Accessed 24 Apr. 2025.

Tong, Noah. “Medicare Advantage Final Rule Excludes Anti-Obesity Drug Coverage under Medicare, Medicaid.” Fiercehealthcare.Com, Fierce Healthcare, 4 Apr. 2025, www.fiercehealthcare.com/payers/medicare-advantage-final-rule-excludes-anti-obesity-drug-coverage-under-medicare-medicaid.

“Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly.” Federalregister.Gov, Federal Register, www.federalregister.gov/documents/2025/04/15/2025-06008/medicare-and-medicaid-programs-contract-year-2026-policy-and-technical-changes-to-the-medicare. Accessed 24 Apr. 2025.

“Medicare Coverage of Anti-Obesity Medications.” Aspe.Hhs.Gov, Assistant Secretary for Planning and Evaluation, 26 Nov. 2024, aspe.hhs.gov/sites/default/files/documents/127bd5b3347b34be31ac5c6b5ed30e6a/medicare-coverage-anti-obesity-meds.pdf.

 

Resources:

2025 Maximum Broker Commissions for Medicare Advantage & Medicare Part D: https://ritterim.com/blog/2025-maximum-broker-commissions-for-medicare-advantage-and-medicare-part-d/

3 Additional Effective Techniques for Closing Insurance Sales: https://lnk.to/asg656

4 Effective Techniques for Closing Insurance Sales: https://lnk.to/asg655

5 Things About the 2026 CMS MA and Part D Rate Announcement: https://lnk.to/asgf20250411

CMS Updates, Content Library, & More! https://lnk.to/asgf20250328

Recent ACA Coverage Changes Reversed with 2025 Marketplace Proposed Rule: https://ritterim.com/blog/recent-aca-changes-reversed-with-2026-marketplace-proposed-rule/

Subscribe to the Ritter Blog: https://ritterim.com/blog/

The Best Appointment Schedulers for Insurance Agents: https://lnk.to/asg657

 

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