The Trump administration has boosted payment rates for Medicare Advantage plans, but is also planning what it calls “aggressive” steps to ramp up audits of potential overpayments.
Here are seven things to know about the Trump administration’s approach to Medicare Advantage so far, and how insurers are responding:
- In May, CMS said it plans to audit each of the more than 500 Medicare Advantage plans for potential overpayments annually. Currently, the agency reviews around 60 plans each year. To support the effort, CMS plans to expand its team of medical coders from 40 to around 2,000 by Sept. 1
- UnitedHealth Group, the nation’s largest Medicare Advantage insurer, said it is supportive of the plan to audit each plan annually.
“We look forward to working with CMS to develop an accurate methodology and appropriately use advanced technology to greatly enhance the auditing process,” the company wrote on LinkedIn May 21. - In May, the Justice Department filed a sweeping lawsuit against Humana, Aetna and Anthem, and multiple Medicare Advantage brokers. The government alleged the insurers and brokers engaged in a multi-year scheme involving unlawful kickbacks and discriminatory practices against disabled MA enrollees.
- In April, CMS said MA plans can expect a payment increase of 5.06% in 2026. The increase is higher than the 3.32% plans received in 2024 and the 3.7% they received in 2023.
Major payer executives said the funding bump is a step in the right direction.
Elevance Health CFO Mark Kaye told investors the increase is “more reflective of actual trends, but doesn’t fully restore the impact of prior underfunding.” - The Trump administration’s final rate notice for 2026 keeps in place the three-year phase-in of risk-adjustment changes from the V24 to V28 model. Many payers have decried the model, saying it amounts to a pay cut for MA plans.
- CMS also published the final rule for Medicare Advantage and Part D plans in April. The agency included measures to streamline prior authorization and increase oversight of supplemental benefits. CMS did not move forward with the Biden administration’s proposal to cover GLP-1 drugs for weight loss under Medicare and did not finalize rules to place guardrails around how plans can use AI in prior authorization decisions.
- As part of the final rule, CMS rebranded the health-equity index reward program. Beginning in 2027, the program will be called Excellent Health Outcomes for All. The change “better captures the goal of ensuring exceptional care for all enrollees,” the agency wrote in its 2026 final rate notice.
Lawmakers on Capitol Hill are also turning their eyes toward Medicare Advantage. Senators have floated including provisions of the ‘No UPCODE’ Act as part of a budget megabill.
The bill, first proposed in 2023, is intended to crack down on improper payments in MA. Insurers oppose the provision, contending the proposal amounts to a cut in Medicare funding.
On June 10, Politico reported the proposal is unlikely to make it into budget legislation, but the measure could be a longer-term priority.
Editor’s note: This article was first published April 28 and last updated June 11.
