Overhauling Medicare Advantage: Proposed Changes for 2026

Complications: Health Policy Unraveled

“Medicare Advantage has come under scrutiny related to mental health providers in their networks and related to broker's fees.” Proposed changes seek to remedy that.

In episode 18 of Complications: Health Policy Unraveled, host Stephanie Kennan details the changes to Medicare Advantage Plans recently proposed by the Senate Finance Committee and CMS. The Senate Finance Committee’s changes are aimed at ensuring accuracy among provider directories. CMS wishes to redefine “compensation” so as to ensure brokers are directing enrollees to the plan best-suited for the patient, not the plan that gives the broker the biggest bonus. The proposed changes would also promote greater access to behavioral health providers and supplemental benefits, especially for the chronically ill.

Tune in to hear about all the proposed changes that may be coming to Medicare Advantage plans.

Meet Your Host

Name: Stephanie Kennan

Title: Senior Vice President, Federal Public Affairs at McGuireWoods Consulting

Specialty: Stephanie Kennan helps clients navigate the legislative and executive branches of the federal government to solve problems involving a variety of healthcare policy issues. Her work focuses on providers, medical device manufacturers, drug manufacturers and associations concerned about Medicare and Medicaid reimbursement.

Connect: LinkedIn

Episode Highlights

[0:30] Senate Finance Committee and CMS have proposed changes to Medicare Advantage, including remedying the issue of “ghost networks” of mental health providers.

[2:14] Medicare Advantage will also be expected to submit annual reports of the accuracy of provider directories to the Secretary of HHS, who would then make the scores public.

[3:12] By 2031, GAO will need to report on in-network cost sharing applied to care by out-of-network providers based on inaccurate directories, provider response rates to outreach methods, and compliance with the duty to submit provider directory accuracy reports.

[4:06] CMS’s proposed changes focus on the use of agents and brokers to navigate the Medicare system, including updating the definition of compensation for such brokers.

[4:39] CMS is concerned that brokers are steering enrollees to plans based on their own compensation and bonus arrangements instead of the enrollee’s best interests.

[6:32] CMS also wants to add various behavioral health services, including mental health and addiction specialists, to one category–Outpatient Behavioral Health–for the purpose of setting adequacy standards.

[8:57] Medicare Advantage plans will be required to demonstrate that they provide research-backed supplemental benefits that have a reasonable expectation of improving the health or overall function of chronically ill enrollees.

Contact

Connect with us on Facebook, Twitter, LinkedIn, YouTube.

Subscribe to Complications: Health Policy Unraveled in your preferred podcast app and never miss a healthcare update by subscribing to host and JD Supra’s #1 healthcare author Stephanie Kennan’s Washington Healthcare Update at www.mwcllc.com