Industry groups warn the flat rates may force plans to cut benefits and raise premiums for millions of seniors. For SNFs, flat MA payment growth to plans typically signals tighter contract negotiations, reduced covered days, and more aggressive utilization management as payers move to protect margins.
CMS is proposing a net average year-over-year Medicare Advantage payment increase of 0.09%, equaling over $700 million in CY 2027. Key policy changes include the use of more current cost data for diseases and conditions and the exclusion of diagnoses from unlinked Chart Review Records beginning in CY 2027. CMS Administrator Dr. Mehmet Oz stated: “By strengthening payment accuracy and modernizing risk adjustment, CMS is helping ensure beneficiaries continue to have affordable plan choices” while protecting taxpayers from unnecessary spending.
— Centers for Medicare & Medicaid Services, January 26, 2026“CMS Proposes 2027 Medicare Advantage and Part D Payment Policies to Improve Payment Accuracy and Sustainability.” Centers for Medicare & Medicaid Services, 26 Jan. 2026. https://www.cms.gov/newsroom/press-releases/cms-proposes-2027-medicare-advantage-part-d-payment-policies-improve-payment-accuracy-sustainability
CMS Proposes Nearly Flat 2027 Medicare Advantage Payment Rates
CMS released its 2027 Advance Notice of Methodological Changes for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies, proposing a net average year-over-year payment increase of .09% in addition to notable updates to risk adjustment. The changes are projected to net a .09% year-to-year payment increase — more than $700 million in additional MA payments in the calendar year 2027. However, the projected increase is significantly lower than the mid-single-digit percentage increase of approximately 4% to 6% that payers expected based on previous years.
— American Journal of Managed Care, January 27, 2026
Medicare Advantage ‘Dark Money’ Group Attempts To Win Higher Payments for Insurance Companies
Judging by more than 16,400 comments recently posted on a federal government website, you’d think there was a groundswell of older Americans demanding that federal officials hike payments to their Medicare Advantage health insurance plans.
Yet about 82% of the comments are identical to a letter that appeared on the website of a secretive advocacy group called Medicare Advantage Majority, a data analysis by KFF Health News has found.
— KFF Health News, March 13, 2026
About 82% of public Medicare Advantage rate notice comments tied to ‘dark money’ group: KFF
About 82% of the more than 16,000 available public comments on the 2027 Medicare Advantage proposed rate notice share the perspective and language of a letter from the Medicare Advantage Majority, a group with undisclosed funding sources and founders, according to a March 12 KFF Health News report.
— Becker’s Payer Issues, March 5, 2026
CMS receives record comments on controversial Medicare Advantage payment proposal
Federal regulators received a record number of comments on their proposal to keep Medicare Advantage rates flat next year, Trump administration officials said Tuesday during an industry event, as insurers continue to lobby heavily for higher reimbursement.
— Healthcare Dive, March 4, 2026
47,000 comments on 2027 Medicare Advantage pay proposal breaks CMS record
Some organizations, like AHIP, have been commissioning research on the proposal, identifying pressure on future benefits and coverage.
When asked about stakeholders that are questioning the payment policies laid out in the advance notice, Mr. Klomp said, “This is why we are taking so many meetings. This is why we are actually reading the comments.”
The final rate announcement is expected April 6.
— Becker’s Payer Issues, March 5, 2026
Federal Government Turns to Fresher Data to Rein In Medicare Advantage Upcoding
CMS is ratcheting down payments to Medicare Advantage plans for enrollees who have common chronic diseases, such as diabetes, morbid obesity, and lung disease, based on analysis showing misalignment between coded conditions and actual clinical care delivery. The proposed data update will reduce payments for two-thirds of diagnostic codes affecting typical enrollees, with supplemental payments for individuals with five or more conditions also impacted.
— STAT News, February 9, 2026
Medicare Advantage Insurers Face New Curbs on Overcharges in Trump Plan That Reins In Payments
A December 2019 HHS Office of Inspector General report found that “over 99 percent of chart reviews in our review added diagnoses,” resulting in an estimated $6.7 billion in improper 2017 payments. Recently, Kaiser Permanente settled for $556 million over allegations of adding approximately 500,000 diagnoses between 2009 and 2018, generating roughly $1 billion in improper payments. CMS Administrator Mehmet Oz stated the proposal aims at “protecting taxpayers from unnecessary spending that is not oriented towards addressing real health needs.”
— KFF Health News, January 29, 2026
CMS Proposes Nearly Flat Medicare Advantage Payments for 2027: 6 Notes
Plans relying heavily on chart review documentation will face greater payment reductions under the new risk score exclusions. Health insurance trade groups criticized the proposal: AHIP warned that modest funding “at a time of sharply rising medical costs” could trigger benefit reductions, while the Alliance of Community Health Plans termed the proposal “disappointing and wholly unrealistic.”
— Becker’s Payer Issues, January 26, 2026
Providers lock in on ratings, I-SNP rules and denials ahead of final ‘27 MA rule
In its formal comments, the American Health Care Association/National Center for Assisted Living called out “egregious utilization management practices by some plans,” saying they continue to significantly impact vulnerable populations and long-term care and post-acute care providers in particular.
“CMS should take steps to curb these behaviors and reinforce timely, appropriate care delivery to protect both beneficiaries and the integrity of provider networks,” wrote John Kane, senior vice president for reimbursement policy, and Nisha Hammel, vice president of reimbursement policy and population health.
— McKnights, February 2, 2026
✔ Comply with every payer's rules
✔ Equip your team with the Playbook
✔ Monitor rates and payer trends
