CMS releases MA and Part D Final Rule and Rate Notice for 2027

The Center for Medicare & Medicaid Services (CMS) recently finalized two Medicare Advantage (MA) payment and policy rules. The Final MA Rate Announcement closely aligns with Cigna’s priorities for maintaining stability, predictability, and payment accuracy across Part D markets. CMS finalized several Cigna-supported policies, including bid-based prospective Employer Group Waiver Plan (EGWP) reinsurance, separate drug hierarchical condition category model segments, and normalization factors for MA prescription drug plans and standalone prescription drug plans.

CMS will assess the need for a 2027 premium stabilization demonstration after reviewing bids and will announce any decision by Summer 2026. In MA, CMS delivered a stronger than expected 2.48% payment increase, a significant improvement over the proposed 0.09%, driven largely by the incorporation of additional data. CMS opted not to recalibrate the MA risk adjustment model with newer data, which will moderate negative payment impacts. CMS also finalized its policy to exclude unlinked chart review diagnoses from risk scores, with a limited exception for beneficiary transitions between MA plans. CMS largely finalized the Policy & Technical Changes rule as proposed.

In particular, the final rule closely tracks our comments on Star Ratings simplification, marketing reforms, burden reduction, and operational clarity. CMS did not finalize policy changes or directly respond to comments on several requests for information on topics such as the future direction of the MA program, modernizing marketing oversight, and agent/broker regulations but indicated that the feedback received will inform future rulemaking.