CMS proposes Medicare Advantage, Part D payment changes for CY 2027

The Centers for Medicare & Medicaid Services Jan. 26 released proposed changes to Medicare Advantage plan capitation rates and Part D payment policies for calendar year 2027, which the agency estimates will result in a net average year-over-year increase of 0.09% in MA plan payments, or $700 million. CMS proposes to address coding differences between MA and Original Medicare, in addition to updating the MA risk adjustment model to reflect current costs associated with various conditions and characteristics. The agency also proposes to exclude diagnosis information from unlinked chart review records from risk score calculation in CY 2027 and solicits feedback on new measures that would incentivize plans from providing unnecessary, inappropriate or low-value care, as well as measures related to medical errors or misdiagnoses. CMS also plans updates to the Part D risk adjustment model. Out-of-pocket prescription drug costs for individuals with Medicare Part D are proposed to be capped at $2,400 in 2027, up from $2,100 in 2026. Comments on the CY 2027 proposals are due Feb. 25. The agency expects to publish a final rate announcement on or before April 6.