Risk adjustment is a crucial component of Medicare Advantage (MA), ensuring that payments to MA plans reflect the health status and risk factors of their enrollees. As the MA population continues to grow, accurate risk adjustment becomes increasingly essential for effective care planning and financial sustainability. With key changes occurring for MA plan benefits by the Centers for Medicare & Medicaid Services (CMS) for Contract Year (CY) 2026—including completing the three-year phase-in of updates to the MA risk adjustment model, updating the Part D risk adjustment model to account for Inflation Reduction Act-related changes, and more—health plans should prepare for these payment adjustments and their potential impact on plan offerings.
Risk adjustment is a crucial component of Medicare Advantage (MA), ensuring that payments to MA plans reflect the health status and risk factors of their enrollees. As the MA population continues to grow, accurate risk adjustment becomes increasingly essential for effective care planning and financial sustainability.
With key changes occurring for MA plan benefits by the Centers for Medicare & Medicaid Services (CMS) for Contract Year (CY) 2026—including completing the three-year phase-in of updates to the MA risk adjustment model, updating the Part D risk adjustment model to account for Inflation Reduction Act-related changes, and more—health plans should prepare for these payment adjustments and their potential impact on plan offerings.
