marketing November 27, 2024

CMS Announces Medicare Advantage and Part D Proposed Rule for CY 2026: Key Impacts for Brokers and TPMOs

Sacramento, Ca- The Centers for Medicare & Medicaid Services (CMS) has announced the proposed rule for Contract Year (CY) 2026 affecting Medicare Advantage (MA) and Medicare Part D programs. These updates aim to improve access to care, address barriers, and enhance transparency for Medicare beneficiaries. Brokers and Third-Party Marketing Organizations (TPMOs) should understand the implications of these changes and have the opportunity to provide feedback.

Key Proposed Changes Relevant to Brokers and TPMOs

1. Marketing Oversight
   • CMS proposes increased oversight of advertisements and marketing practices to protect beneficiaries from misleading content. These changes may require brokers and TPMOs to adjust marketing strategies to comply with stricter regulations.
2. Provider Directories Integration
   • MA plans will be required to share full provider directories with CMS for inclusion in Medicare Plan Finder. This change aims to enhance transparency and enable beneficiaries to make informed decisions, potentially altering how brokers present plan options.
3. Prior Authorization Reforms
   • New guardrails are proposed to reduce inappropriate use of prior authorization processes. Brokers will need to stay informed about these updates, which aim to streamline care access for beneficiaries.
4. Anti-Obesity Medication Coverage
   • CMS proposes reinterpreting Part D rules to cover anti-obesity medications. This expansion may influence client plan choices and discussions regarding health benefits.

5. Medical Loss Ratio (MLR) Updates
   • Adjustments to reporting requirements for MA and Part D MLRs aim to promote transparency and address concerns about vertical integration.

HOW TO TAKE ACTION:

Watch for the Opportunity: Stay alert for when the comment period opens to submit your feedback.

Read the Proposal: Review the unpublished document here.

Stay Tuned: Once the comment period opens, check the Federal Register for the opportunity to submit your comments.

Why Participation Matters

These proposed changes directly affect how brokers and TPMOs operate, interact with clients, and comply with marketing and administrative requirements. By submitting comments, you can:

• Provide insights on how these changes impact your operations and client interactions.
• Suggest practical adjustments to proposed policies.
• Contribute to shaping a regulatory framework that supports Medicare beneficiaries and the professionals who serve them.

To review or comment on the CY 2026 MA and Part D proposed rule during its 60-day public comment period, visit the Federal Register.

For more information on the CY 2026 MA and Part D proposed rule, view the fact sheet. 

View the full Press Release here.

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For over 30 years, SAHU has worked to improve our members’ ability to meet the health, financial and retirement security needs of all Californians and Americans through education, advocacy, and professional development. For more information, please visit: sahu-ca.com.