Jun 19, 2025

Medicare Advantage Plans Are Facing Changes in 2026

CMS is introducing key Medicare Advantage changes in 2026 to improve care transparency and reduce misuse.

Here's What You Need to Know

If you're one of the more than 30 million Americans enrolled in a Medicare Advantage (MA) plan, this year could bring important changes that impact how your plan works — and what services you can expect.

The Centers for Medicare & Medicaid Services (CMS) is taking a closer look at how Medicare Advantage insurers operate, especially around billing practices and at-home assessments that have drawn criticism in recent years. Here’s a breakdown of what’s happening and why it matters for you.

Why Medicare Advantage Is Under the Microscope

MA plans — which are offered by private insurers approved by Medicare — have grown in popularity thanks to their all-in-one coverage and often low premiums. But with that growth has come increased scrutiny.

A recent Wall Street Journal article (read it here) highlighted concerns around how some insurers use in-home assessments to document diagnoses that may boost payments from Medicare. While these assessments can help identify health risks early, critics argue they’re sometimes used more to increase revenue than to improve patient outcomes.

CMS is now moving to tighten the rules. The agency has proposed new guidelines that would reduce payments tied to certain diagnoses unless they are confirmed by a clinical visit or are clearly tied to ongoing care.

What This Means for Your Plan

These changes could affect how your Medicare Advantage plan delivers care — particularly around follow-ups, risk assessments, and proactive outreach.

For example:

You may notice fewer unsolicited at-home health check offers
Some conditions might require more in-person follow-up to stay covered
Plans may update how they structure care teams or coordinate chronic care services

While the goal is to eliminate unnecessary or duplicative billing, CMS also wants to ensure that MA enrollees continue to receive quality, coordinated care.

What You Can Do

Stay Informed: Keep an eye on communication from your plan, especially if services you’ve used in the past are changing.
Ask Questions: If your care coordination or follow-up process seems different, ask why. These changes should be transparent.
Use Your Benefits: Make the most of what is included in your current plan.
Talk to a Licensed Insurance Agent: If you’re unsure how these changes affect your care or coverage, speak with a licensed insurance agent who can walk you through your options.

The Bottom Line

CMS’s actions reflect a growing effort to make Medicare Advantage more accountable and patient-centered. While that may mean some short-term adjustments for plans and providers, the long-term goal is to ensure your coverage is based on care you actually need, not just what increases insurer profits.

At Silvur Insurance, we’re here to help you navigate every change and make the most of your Medicare Plan benefits. Questions? Reach out to our team today for a one-on-one conversation about your coverage.

Our licensed, Michigan-based insurance professionals will help you find and enroll in the best Medicare plan for your unique needs.

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Delaware Insurance Producer License No. 3003086360. All rights reserved.We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options. Currently, we offer 10 Medicare organizations which offer 87 products in your area. To send a complaint to Medicare, call 1-800-MEDICARE (TTY users should call 1- 877-701-2460), 24 hours a day/7 days a week).Silvur Insurance Services LLC is a licensed and certified representative of Medicare Advantage organizations and stand-alone prescription drug plans. Each of the organizations/plans we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion.This website is operated by Silvur Insurance Services LLC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in an insurance plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual circumstances. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.This website does not contain a complete description of plan benefits. Call the Plan’s customer service phone number for more information. Not affiliated with the U. S. government or federal Medicare program. This is a solicitation for Insurance. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

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Medicare Advantage Plans Are Facing Changes in 2026

Why Medicare Advantage Is Under the Microscope

What This Means for Your Plan

What You Can Do

The Bottom Line

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