Story perspectives

Medicare Advantage Plans to Receive $76B Boost Amid Coverage Concerns

1/22/2026

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Summary

Story summary

Centers for Medicare & Medicaid Services (CMS) will pay Medicare Advantage plans $76 billion more in 2026 than traditional Medicare.
The increase follows a 2024 policy limiting MA plans' exaggeration of health risks.
The disparity arises from coding intensity and favorable selection of healthier MA patients.
University of Michigan study finds telehealth has not risen since 2020, raising coverage concerns.
Experts call for adjustments to protect access and address fraud.

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Story summary

Centers for Medicare & Medicaid Services (CMS) will pay Medicare Advantage plans $76 billion more in 2026 than traditional Medicare.
The increase follows a 2024 policy limiting MA plans' exaggeration of health risks.
The disparity arises from coding intensity and favorable selection of healthier MA patients.
University of Michigan study finds telehealth has not risen since 2020, raising coverage concerns.
Experts call for adjustments to protect access and address fraud.