The Centers for Medicare & Medicaid Services has announced that it will increase the benchmarks paid to Medicare Advantage plans by an average of 5.06% for calendar year 2026. This is an increase of 2.83 percentage points since the 2026 Advance Notice. CMS attributed the 5.06% increase to an increase in the effective growth rate, largely due to the inclusion of additional data on fee-for-service expenditures, including payments through the end of 2024. The methodology for setting the effective growth rate is set by statute.
CMS’s press release regarding the payment increase is linked here.
Whatley Kallas, LLP’s provider clients have reported increased denials and underpayments of claims by Medicare Advantage plans, which Whatley Kallas is pursuing on their behalf. The attorneys at Whatley Kallas hope that Medicare Advantage plans use the increase in benchmark payments to increase payments to healthcare providers.