A new piece in Health Affairs examines the Centers for Medicare and Medicaid Services’ (CMS) ongoing efforts to rein in excess spending within the Medicare Advantage program. The 2027 Advance Notice, released early in 2026, proposed a tight 0.09% payment increase for insurers, signaling a stricter regulatory environment.
One of the most notable proposals is CMS’s intent to remove diagnosis codes captured exclusively through “unlinked chart reviews” when calculating risk scores. Researchers estimate this coding intensity has historically led to billions in overpayments to private plans compared to traditional fee-for-service Medicare.
The article suggests these regulatory adjustments are a necessary first step to ensure the financial sustainability of the $647-billion-a-year program while protecting the quality of care for beneficiaries.