Medicare and Medicaid Programs; Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).

This final rule revises the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), Medicare cost plan, and Programs of All-Inclusive Care for the Elderly (PACE) regulations to implement changes related to prescription drug coverage, the Medicare Prescription Payment Plan, dual eligible special needs plans (D-SNPs), Part C and D Star Ratings, and other programmatic areas, including the Medicare Drug Price Negotiation Program. This final rule also codifies existing sub-regulatory guidance in the Part C and Part D programs.

Effective date: These regulations are effective June 3, 2025.

Applicability dates: The provisions in this rule are applicable to coverage beginning January 1, 2026, except as otherwise noted. The updates to marketing and communication provisions at §§ 422.2267(e)(30) and 423.2267(e)(32) for integrated member ID cards are applicable for all contract year (CY) 2027 marketing and communications beginning October 1, 2026. The requirements related to eligibility and election, targeted outreach, and general outreach regarding participation in the Medicare Prescription Payment Plan for 2026 at §§ 423.2267(e)(45) through (51), 423.2265(b)(16), and 423.137(d), (e), and (m) are applicable beginning October 1, 2025. The health risk assessment (HRA) provision that we are finalizing at § 422.101(f)(1)(v) is applicable beginning October 1, 2026, for HRAs conducted for effective dates of enrollment on or after January 1, 2027. The addition of the updated Part C Breast Cancer Screening measure as described in section III.E. of the final rule is applicable for 2029 Star Ratings beginning January 1, 2027.