Mini-webinar Rundown
- Revenue Boost, But With Strings Attached. CMS finalized an average 5% revenue increase for MA plans in 2026, driven primarily by higher fee-for-service Medicare costs. While this is a financial positive, it comes with heightened regulatory scrutiny and rising expectations around access, quality, and fiduciary responsibility.
- Inflation Reduction Act Becomes Reality. Several IRA provisions are now formally codified: $2,000 annual out-of-pocket cap for Part D, Manufacturer discount program, and the N3P monthly cost smoothing program. These changes mean more financial risk for plans, particularly in the catastrophic phase of Part D coverage.
- Stars & Quality: Be Proactive, Not Reactive. Breast cancer screening measures will expand to include ages 40-49 by 2027. Plans should begin analyzing this population now. For D-SNPs, integration is no longer optional. Plans must implement integrated IDs and HRAs by 2027 and prepare for enhanced alignment requirements.
- SSBCI Nutrition Restrictions Are Coming. CMS will prohibit coverage of “non-healthy” food under SSBCI starting in 2026. Plans should proactively redefine benefits, update FlexCards, and communicate changes to avoid member frustration and Stars penalties.
- Unaddressed but Critical: AI, Obesity Drugs, and More. Despite growing use of AI in UM and coding, CMS has not yet issued clear guardrails—plans piloting AI should implement governance policies now. No final decision on GLP-1 or anti-obesity drug coverage, but mounting pressure suggests this could become a major financial and policy issue soon.
Speakers
- Dr. Ed Likovich, PHD, CEO of Nymbl.
- Jessica Muratore, Strategic healthcare advisor helping health plans and vendors navigate complex government programs.
- Andrew Bell, Managing Director at Prosphire, a national healthcare consulting firm, overseeing their Medicare Advantage practice.
Book a Meeting
Jeff Voss
SVP of Sales
.png?width=300&height=39&name=Book%20a%20meeting%20button%20(2).png){kind=small}