On April 6, the Centers for Medicare and Medicaid Services (CMS) announced it will provide Medicare Advantage (MA) plans a 2.48 percent rate increase in 2027, totaling $13 billion. By comparison, MA plans received $25 billion for 2026.
As previously reported by ASGE, the Trump administration initially proposed in January nearly flat 2027 funding for MA plans.
CMS did not move forward in the final rule with an updated risk adjustment system for 2027. It did, however, finalize that, beginning in 2027, chart review records not associated with a provider appointment will be excluded when calculating MA plans’ risk scores. As a result, diagnoses that are not associated with a service will not be considered for risk adjustment.
Even though CMS did not finalize a new risk adjustment system, the Agency did not abandon it. The expectation of future changes and a modest rate increase for 2027 is fueling speculation that MA plans will respond by cutting benefits or increasing utilization control efforts in the future.