A more financially stable MA payer environment may reduce negotiating pressure for SNFs during 2026 contracting cycles, though industry experts caution the increase alone is unlikely to produce meaningful rate gains for providers.
CMS Releases Proposed 2026 Payment Policy Updates for Medicare Advantage and Part D Programs
“Payments from the government to MA plans are expected to increase on average by 4.33%, or over $21 billion, from 2025 to 2026, as proposed.”
— CMS, January 17, 2025
2026 Medicare Advantage and Part D Advance Notice Fact Sheet
“CMS proposes to complete its implementation of a three-year phase-in of improvements to the MA risk adjustment model and growth rate calculation related to medical education costs, as well as other technical improvements.”
— CMS, January 17, 2025
“To some extent, I could see a situation where there’s slightly less downward pressure on rates, or possibly a somewhat more favorable environment for negotiations if plans are receiving higher payments. That said, it’s important to note that this won’t lead to significant rate increases or make negotiations with MA plans any easier. However, if [MA plans] are not under the same financial strain they’ve been facing over the past two years, that could make a difference.”
— Skilled Nursing News, January 13, 2025
Medicare Advantage Increase for Payers, not Providers
“On January 13, 2025, CMS announced its plans to increase payments to Medicare Advantage plans by 4.33%… The changes, however, don’t increase payments to the people actually providing the care, only to the payers.”
— The Rowan Report, January 23, 2025
CMS Releases Proposed 2026 MA Payment Policy Updates
“The proposed policies are projected to result in an average increase of 4.33% – over $21 billion – in Medicare Advantage (MA) rates from 2025 to 2026. However, plan specific rates will vary as the projection factors in several other modifiers, including risk adjustment.”
— AHCA/NCAL, January 15, 2025
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