Final 2026 Medicare Advantage Rule: What’s In, What’s Out and What’s to Come

Apr 17
Apr 17, 2025

On April 4, CMS released its highly anticipated rule finalizing Medicare Advantage and Part D program changes for 2026 that were introduced under former President Joe Biden. Nearly 300 pages shorter than the November version proposed by CMS, the final rule left out 12 sections altogether, including one seeking to expand coverage of anti-obesity medications and others that would have impacted MA plans' marketing practices and use of artificial intelligence, among other things. Industry experts say that doesn’t mean the agency won’t revisit those topics and put its own stamp on them under President Donald Trump.

“What was in [the final rule] was very little. Other than closing the chapter for now on GLP-1s and a few little relatively innocuous pieces around dual eligibles, most everything else was tabled,” remarks Melissa Newton Smith, founder of Newton Smith Group.
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Lauren Flynn Kelly

Lauren has been covering health business issues since the early 2000s and specializes in in-depth reporting on Medicare Advantage, managed Medicaid and Medicare Part D. She also possesses a deep understanding of the complex world of pharmacy benefit management, having written AIS Health’s Radar on Drug Benefits from 2004 to 2005 and again from 2011 to 2016. In addition to her role as managing editor of Radar on Medicare Advantage, she oversees AIS Health’s publications and manages the health editorial staff. She graduated from Vassar College with a B.A. in English.