CMS issued some major regulatory proposals in its draft 2026 Medicare Advantage and Part D rule.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the recently released draft 2026 Medicare Advantage (MA) and Part D rule. Some major regulatory changes are in store for plans.

Key Takeaways:

The proposed CMS MA and Part D rule for 2027 was issued timely despite the government shutdown. It includes some significant changes.

The Star changes were the biggest, including repeal of the Excellent Health Outcomes for All equity reward and the sunset of operational measures.

CMS' focus in the balance of the rule is reducing regulatory burden and streamlining regulations.

Various utilization management health equity requirements codified by the Biden administration are proposed for repeal.

Four RFIs were issued, including seeking input on reforming the risk adjustment and Stars programs due to perceived overpayments as well as poor quality outcomes.

As with the rule, new program audit guidance from CMS streamlines the audit process and follow-up.

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance