It’s been busy this week in the Medicare Advantage space. Here’s what captured our attention:
2026 Star ratings cut points released
The Centers for Medicare & Medicaid Services (CMS) on Tuesday released the 2026 Medicare Advantage Star Rating Technical Notes in the Second Plan Preview, which includes measure level cut point changes.
Sixty percent of all cut points will be harder as well 60 percent of 4-Star cut points, notes industry expert Melissa Newton Smith, founder, senior advisor of the Newton Smith Group. In a LinkedIn post, Smith said that CMS isn’t making things harder for Medicare Advantage plans. Rather, the agency assigns cut points based on the relative performance of Medicare Advantage plan performance. “Industry changes and continued free market competition and innovation continues shifting Stars cut points upwards,” she wrote.
For an analysis of the changes, check out this white paper from Wakely.
CMS delays notification of unused supplemental benefits
CMS has paused a requirement that called for Medicare Advantage plans to send mid-year reminders to members about their unused supplemental benefits.
In a memo sent to plans on Monday, the agency said it is delaying enforcement of the supplemental benefits notification while it reconsiders the regulatory requirements. However, plans may voluntarily provide the notices if they choose.
The requirement was originally set to take effect on January 1, 2026.
New report challenges MedPAC’s MA cost analysis
The Healthcare Leadership Council (HLC), an association of health care CEOs and C-suite executives, released a report this week that challenges the accuracy of recent Medicare Advantage (MA) spending estimates by the Medicare Payment Advisory Commission (MedPAC).
The report, “Setting the Record Straight: The Facts Behind MedPAC’s Misleading Cost Analysis of Medicare Advantage,” said flaws in the methodology led to skewed estimates. HLC said the revised methodology was introduced last year and then applied retroactively to previous estimates. The results dramatically inflate Medicare Advantage payment compared to traditional fee-for-service Medicare.
Better Medicare Alliance, a research and advocacy organization that supports Medicare Advantage, said in a statement that the changes to CMS’ methodology nearly quadrupled MedPAC’s estimate of Medicare Advantage “overpayments” in 2024 — without any change in the actual program.” The HLC report shows that the MedPAC method paints a “misleading” picture of Medicare Advantage.
“This is more than a technical dispute,” Better Medicare Alliance said.” Policymakers often rely on MedPAC data to make important decisions about Medicare Advantage — but when the numbers are distorted, it changes the conversation and can put millions of seniors’ health care at risk.”
Study: MA members had longer hospital stays compared to traditional Medicare beneficiaries
A new study published in JAMA Internal Medicine finds that Medicare Advantage members had disproportionately longer hospital stays than those who are in traditional Medicare.
The retrospective cohort study of 89 million hospitalizations used Medicare claims data from 2017 through the third quarter of 2023 that included short-stay inpatient admissions to acute care and critical access hospitals in the United States. Researchers conducted an adjusted analyses on a 20 percent random sample, with subgroup analyses of patients discharged to skilled nursing facilities. The data was analyzed from June 2024 to June 2025.
Among the findings:
- Mean length of stay for Medicare Advantage admissions increase from six to 7.1 days compared to traditional Medicare, which had an increase from 5.8 to 6.3 days.
- Medicare Advantage admissions were 1.2 percent more likely than traditional Medicare admissions to last 14 or more days.
- Medicare Advantage members discharged to skilled nursing facilities had a 3.1 percent adjusted probability of admissions lasting 14 or more days.
- In 2022, prolonged stays among Medicare Advantage patients accounted for an estimated 1.8 additional hospital bed days, which is the equivalent to 288,000 additional admissions with average length of stay.
Researchers said the trends may reflect insurance-related discharge barriers that contributed to millions of additional hospital bed-days. As Medicare Advantage enrollment continues to grow, the study authors said it may be critical to address barriers to discharge to improve hospital throughput and patient outcomes.
California study shows the difference of health care costs between Medicare and Medicare Advantage
A new report from the UCLA Center for Health Policy Research that examined trends in health care costs for seniors between 2013 and 2023, found costs dramatically increased for older adults traditional Medicare compared to older adults with Medicare Advantage.
The report updated the California Elder Index™, an e evidence-based equity tool that provides estimates for basic living costs such as housing, health care, food, transportation, and limited miscellaneous expenses faced by adults ages 65 and older.
Using data from the CMS, the California Elder Index™ looked at Medicare Advantage enrollment rates for all 58 California counties. Counties with higher enrollment rates in traditional Medicare had higher monthly health care costs. The average increase was from $361 in 2013 to $557 in 2023 for a single older adult.
In comparison, counties with Medicare Advantage enrollment rates of at least 20 percent had lower health care costs and a much smaller increase, from $245 to $273. The average monthly health care cost across all California counties for a single older adult grew from $302 in 2013 to $412 in 2023.