CMS proposes 2027 changes to Medicare policies.

CMS proposed payment and policy updates for 2027 affecting Medicare Advantage and Part D, including a projected 0.09% average increase in Medicare Advantage payments and changes to risk adjustment and star ratings; public comments on the Advance Notice are due Feb. 25, 2026.

The Centers for Medicare & Medicaid Services (CMS) has issued a proposal outlining payment and policy updates for 2027 that affect Medicare Advantage (Part C) and Medicare Part D. The agency said the changes aim to align payments with more current costs and to reduce reliance on diagnoses that are not tied to clinical services. Proposed items include updates to risk adjustment methods, limits on certain chart-review diagnoses that are not linked to care, and clarifications to the Star Ratings system. CMS described the effort as intended to keep plan choices and benefits reliable while protecting taxpayers. Key details: - Net payment change: CMS projects a 0.09 percent average increase in year-over-year Medicare Advantage payments for 2027, described as more than $700 million in total, and an expected 2.54 percent average change after accounting for risk-score shifts. - Risk adjustment: CMS will keep its current risk-adjustment framework (Version 28) but plans to use diagnoses from 2023 and cost data from 2024 to update payment calculations. - Unlinked chart review records: CMS proposes not to count certain diagnoses that plans submit from chart or paperwork reviews if those diagnoses are not linked to an actual doctor visit or medical service starting in 2027. - Star ratings: The 2027 updates to the Star Ratings system include a list of disasters that will be considered when adjusting scores, rule clarifications, and a published list of which performance measures will count toward 2027 ratings and improvement scores. - Process and timeline: Stakeholders may submit comments on the Advance Notice through Feb. 25, 2026; CMS said it plans to issue a final Rate Announcement by April 6, 2026. A separate rulemaking for Contract Year 2027, covering broader program changes, had a comment deadline of Jan. 26, 2026. Summary: The proposal would change how payments and quality scores are calculated for Medicare Advantage plans and Part D sponsors, with CMS saying the goal is to better reflect current clinical costs and reduce reliance on non-clinical coding practices. Final determinations will follow the public comment period that closes Feb. 25, 2026 and the planned final Rate Announcement on April 6, 2026.