Trade group urges pause on sweeping Medicare Advantage proposed rule

An organization representing Medicare Advantage insurers is asking CMS to pause any policy changes to the program not required by law in 2026. 

In a Jan. 28 press release, the Better Medicare Alliance, a pro-MA group backed by several major insurers, urged the agency to prioritize "stability" in its 2026 proposed rule. 

In November, the Biden administration pitched several major regulatory changes for 2026, including requiring Medicare to cover GLP-1 drugs for individuals with obesity. 

Here are five things to note: 

  1. In a letter to acting CMS Administrator Jeff Wu, the Alliance said it would not comment on the overall proposal to cover GLP-1 drugs, but urged the agency to "consider the unintended consequences" that could arise from the provision. 

  2. The proposed rule also expands the definition of marketing to subject more MA marketing materials to agency review. In its letter, the Alliance said it supports creating an environment where "beneficiaries are not misled" and are "well-informed," but urged the agency to finalize "reasonable review periods" to ensure marketing materials are not held up in approval processes. 

  3. CMS proposed new guardrails for MA plans' use of AI, requiring organizations to ensure services are provided equitably, whether they are provided by a human or AI. In its letter, the Alliance wrote that it "appreciates the ongoing commitment to ensuring equitable care," but urged CMS to work with stakeholders to develop the guardrails to "fully realize the benefits of artificial intelligence." 

  4. The Alliance asked CMS to delay until 2027 the integration of  MA plans network with Medicare's online tool that beneficiaries use to shop for plans.

  5. The organization also asked CMS to  extend the value-based insurance design model until at least 2027. In December, the agency said it would sunset the model in 2026, citing "unprecedented" costs to the Medicare trust fund. 

The American Hospital Association wrote a letter in support of proposed changes. 

The rule also includes "important protections for MA beneficiaries and clarifications for Medicare Advantage organizations that will improve how coverage works for enrollees, promote more timely access to care … and reduce the administrative burden of health plan requirements on health care providers," wrote Ashley Thompson, senior vice president of public policy and development at the AHA.

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