This week’s series covers:
- 2026 Medicare Final Rule Supports LTC Providers, Relaxes AI Oversight, Excludes Obesity Drug Coverage
- 2026 Medicare Rate Adjustment Benefits Insurers, Pressures Physicians, Raises Access Concerns
- Evolving Medicare Advantage Trends: Implications for Access, Choice, and Equity
Missed Last Week’s Healthcare.com Roundup? Here’s what happened:
- April 4, 2025
- March 19, 2025
- March 12, 2025
- March 3, 2025
- February 25, 2025
- February 13, 2025
- February 5, 2025
- January 31, 2025
- January 22, 2025
- January 15, 2025
- January 8, 2025
Final 2026 Medicare Rule Favors LTC Providers, Scales Back AI Safeguards, Nixes Obesity Drug Coverage
Last week, CMS finalized updates to Medicare Advantage (MA), Part D, and related programs for Contract Year 2026, including changes to drug coverage, D-SNPs, Star Ratings, and the Medicare Drug Price Negotiation Program. The rule strengthens protections by limiting MA plans’ ability to reverse approved inpatient admissions, closing appeals loopholes, and setting boundaries for supplemental benefits while streamlining services for dually eligible enrollees.
These changes matter to consumers because they enhance access, transparency, and protections in coverage decisions; for insurance brokers, agents, and carriers, the rule introduces new compliance requirements, product design considerations, and potential shifts in plan competitiveness.
Some proposed provisions—such as those involving AI guardrails and anti-obesity drug coverage—were not finalized and may be addressed in future rulemaking.
2026 Medicare Rate Hike Boosts Insurers, Squeezes Physicians, and Raises Access Questions
The 2026 Medicare rate adjustment finalizes a 5.06% average payment increase for Medicare Advantage plans, delivering over $25 billion in added funding to insurers, which boosted stock prices and may support expanded benefits. However, physicians face a 2.8% cut in Medicare payments, contrasting with rising practice costs, which could strain provider networks and limit patient access. For consumers, this means stable or improved MA plan options, but potential risks to care access if provider participation declines.
Medicare Advantage Trends and Their Impact on Access, Choice, and Equity
Medicare Advantage enrollment has more than quadrupled since the mid-2000s, now covering over half of all Medicare beneficiaries, according to a report by Research Scientists at the University of Southern California, Grace McCormack and Victoria Shier.
This growth has been fueled in part by employers, including 13 state governments, who offer subsidies exclusively for Medicare Advantage, eliminating subsidized access to Medigap plans that supplement traditional Medicare.
The report highlights that lower-income individuals and racial and ethnic minorities are disproportionately funneled into Medicare Advantage, often due to financial constraints and limited plan options. Geographic disparities persist, with enrollment ranging from just 2% in Alaska to over 60% in states like Alabama and Michigan, raising concerns about equitable access and choice. In these 13 states, where retirement health benefits do not offer Medigap, retirees are effectively required to enroll in Medicare Advantage or face the full cost of supplemental coverage on their own.
Researchers warn that this trend may increase inequality, as healthier and wealthier individuals retain access to more flexible care through traditional Medicare and Medigap, while others are left with fewer options and more restrictions.
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