During a RISE webinar this week on how to navigate the 2026 Medicare Advantage Final Rule, industry experts discussed strategies for compliance as well as what the future may hold under the Trump administration.
Despite what is—and isn’t—included in the Final Rule and Final Rate Notice, the new administration has made it clear that it is setting new priorities for Medicare and Medicaid, according to speaker Melissa Smith, founder, Newton Smith Group.
She said that Trump and Department of Health and Human Services (HHS) Secretary Robert F. Kennedy have been forthright about those concerns.
“They are putting us on a new path in Medicare Advantage than we’ve seen for the last four to six years,” Smith said, “including the tail end of the Trump One administration.”
Kennedy and newly confirmed Centers for Medicare & Medicaid Services (CMS) Administrator Dr. Mehmet Oz have indicated they plan to tackle long-standing problems that Medicare Advantage plans have grappled with over the years. “Things like MAHA, Making America Healthy Again, things like personal choice, price transparency, intentional decision-making while reining in Medicaid and focusing on real health, not lists and processes and old procedures,” Smith said.
In addition, Kennedy and Dr. Oz have said they plan for Medicare Advantage plans to take on artificial intelligence. “We've got a lot of priorities this administration plans for us as the drivers to take on through the policies, changes that come out of this administration both in the 2026 Final Rule and maybe, more importantly, in what will come after the current 2026 Final Rule,” she added.
While most of the Final Rule and Final Rate Notice don’t include Kennedy or Dr. Oz’s take on Medicare, she said that the administration has been weighing Medicaid cuts and possible changes to risk adjustment and quality bonus payments. “These were not in the Final Rule but it’s important to pay attention to,” Smith said.
However, there is one section of the Final Rule that does reflect Kennedy’s philosophy, according to Smith: Establishing that non-healthy foods are prohibited as a special supplemental benefit for the chronically ill. Kennedy has spoken for years about food in the context of chronic illness in children and now is bringing that concept to adults and seniors on Medicare, Smith noted.
Co-speaker Ana Handshuh, principal, CAT5 Strategies, said that both Dr. Oz and Kennedy are generally supportive of Medicare Advantage, and the Final Rate Notice did create a more positive financial environment for the industry.
However, she predicts that the industry will face additional expectations in the upcoming year. Those expectations include more accurate risk adjustment and coding, meeting the requirements of supplemental benefits and who they should go to, and making it more difficult to earn those quality bonus pay. She also predicts that the industry may see guidance on a crackdown of deceptive marketing practices and ghost networks.
Smith said she was struck in the commentary within the Final Rule about simplification, such as decreasing the number of measures because they’ve become complex and complicated. “I do wonder though are we going to complicate things further by trying to uncomplicate things,” she said. “And I think that’s something we’re going to have to watch really closely as we move forward.”
In addition, the speakers, including Tina Dueringer BSN, R.N., CCM, CEO, and principal advisor, Dueringer Advisors, Inc., said the 2026 Final Rule may be one of the last sets of Medicare changes done under notice and comment rulemaking. Instead, future regulations may be made via interim final rulemaking with no warning, grace period, or planning during the proposal period.
Items that were proposed in the Advance Notice but weren’t codified or closed in the Final Rule are still under consideration. The speakers said that those topics could come up in guidance or rulemaking this year. Among those proposals:
Marketing materials: The Biden administration proposed a narrower definition of marketing materials, requiring CMS to review more materials to oversee enrollment influence. The Trump administration is pursuing Department of Justice investigations in sales and marketing practices but has not yet redefined marketing standards.
Provider directories on Medicare Plan Finder: The Advance Notice proposed plans post provider directories on Medicare Plan Finder effective November 2026. The proposal aimed to allow beneficiaries to easily check if their providers were in-network before selecting a plan.
Medical Loss Ratio (MLR) computation: Proposed changes to MLR computation, including handling of provider incentives and administrative costs, aimed to address the vertical integration of large insurers and providers.
Flex cards: The Biden administration proposed communication method changes for flex cards to protect beneficiaries from potential "bribery" or "kickbacks." Speakers said the Trump administration is still evaluating these strategies and access to these cards. CMS had similar concerns regarding over-the-counter benefits and prepaid debit cards.