Summary
Finalizes Contract Year 2026 policy and technical changes for Medicare Advantage (Part C), Part D, cost plans, and for the Program of All-Inclusive Care for the Elderly, including adjustments to the Medicare Prescription Payment Plan, D‑SNPs, Star Ratings, utilization management, and other programmatic areas. Implements Inflation Reduction Act‑related changes and clarifies several beneficiary protections.
Healthcare Implications
Affects plan operations, prior authorization, and beneficiary communications–areas where plans increasingly use AI for triage, utilization review, and member outreach. Transparency and documentation requirements inform how AI‑assisted workflows must be governed. Providers may experience updated prior authorization processes and data exchange with Medicare Advantage/Part D plans.