Contact: Jenifer Callahan, Chief of Staff
Email: jcallahan@apg.org
Phone: (703) 282-3027
Washington, DC, April 6, 2026 – Changes made by the Centers for Medicare & Medicaid Services in its issuance of final Medicare Advantage (MA) and Part D rates for 2027 moved considerably toward ensuring greater stability in the MA program, America’s Physician Groups said today. At the same time, additional changes will be needed in future years to ensure that medical groups and other health care providers closely partnered with MA plans have sufficient resources to care for enrollees.
“We are grateful that CMS listened to stakeholders and made important adaptations in the final rate notice,” said Susan Dentzer, APG’s president and chief executive officer. “Amid the aging of the MA population, and rising rates of health care utilization and costs, we will continue to work with the agency to ensure that MA remains a vibrant program well suited to meeting enrollees’ growing needs.”
APG specifically welcomed these important changes from the original Advance Notice issued on January 26, 2026 to the final rate notice released today:
- A small increase in the estimated growth in MA benchmarks that will be used to determine payment for MA plans in 2027, up from the original 4.97 percent January number to 5.33 percent now. CMS noted that the change was due to incorporating more data from actual spending in the Original Medicare program through year-end 2025.
- An overall expected average change in payment to MA plans of 2.48 percent in 2027, up from 0.09 percent number released in January. Although APG believes that this average increase in payment will still be below the actual trendline in health care spending growth for MA plans, the increase is welcome.
- The decision by CMS not to implement a new 2027 MA risk adjustment model and to essentially retain the 2024 model for at least another year. APG very much appreciates CMS’s statement that it acknowledged APG’s and other commenter’s concern about stability in the MA market and the need to allow “more time to adjust to the completed phase in” of the 2024 risk adjustment model.
- A welcome exception in the finalized policy to exclude — for the purposes of risk adjustment — diagnoses derived through chart reviews that are not linked to health plan encounter data. This exception would apply to MA enrollees who switched from one MA plan to another from one year to the next. APG had originally asked for a delay in implementing the new policy to allow more time to bring data exchange up to speed, but creating this exception for diagnoses related to enrollees who switch plans will nonetheless be helpful.
APG continues to have some reservations about CMS’s separate decision to exclude for the purposes of risk adjustment diagnoses from audio-only telehealth encounters. APG had expressed concerns that many vulnerable patients in underserved areas continue to lack reliable access to the internet for video encounters and rely on their phones for contact with health care providers. APG expresses the hope that CMS will study the effect of this change and determine whether it is truly in the best interests of many patients.
About America’s Physician Groups
APG’s more than 300 physician groups comprise roughly 300,000 physicians and other clinicians providing care to nearly 90 million patients, including about 1 in 3 Americans and 1 in 3 Medicare Advantage enrollees. APG’s motto, ‘Taking Responsibility for America’s Health,’ represents our members’ commitment to clinically integrated, coordinated, value-based health care in which physician groups are accountable for the costs and quality of patient care. Visit us at www.apg.org.
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