The US Centers for Medicare & Medicaid Services (CMS) has finalised a rule that will boost payments for Medicare Advantage (MA) insurers next year.
The package will produce a net average increase of 2.48% in MA payments for 2027, translating to more than $13bn in extra payments to plans.
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The agency said the estimate reflects several moving parts including changes in underlying cost trends, 2026 Star Ratings used to calculate 2027 quality bonus payments, and adjustments to risk-scoring methods.
Among the main policy changes, it is seeking to narrow differences in diagnosis coding between MA and Original Medicare.
It described three goals for the direction of its risk-adjustment approach: making processes simpler for plans and providers, supporting competition regardless of plan size, and aligning payments more closely with beneficiaries’ health risk while supporting efficient resource use, programme integrity and accountability.
The CMS also said it will continue using the 2024 MA risk-adjustment model in 2027, pointing to its effects during 2024–26, and will review public comments when considering later revisions.
From 2027, the agency plans to remove diagnosis entries drawn from “unlinked” chart reviews – records not tied to a specific patient encounter – from risk score calculations, except where a beneficiary moves from one MA organisation to another.
The CMS said this will likely have a larger payment effect on organisations that depend heavily on unlinked chart review submissions for risk-adjustment eligible diagnoses.
In January, US President Donald Trump sent a legislative healthcare proposal to Congress intended to cut prescription drug costs and insurance premiums.
The plan, referred to as the Great Healthcare Plan, includes steps aimed at adopting drug pricing approaches used in other countries and at “maximise price transparency”, according to a White House fact sheet.
