The Centers for Medicare & Medicaid Services (CMS) has finalized its 2026 rule for Medicare Advantage (MA) and Part D plans, introducing several reforms aimed at improving transparency, care coordination, and patient access. The new rule will impact how physicians interact with MA plans and administer care to Medicare beneficiaries.

Key changes include:

• Stronger oversight of prior authorization to reduce care delays and streamline renewals for ongoing treatments.
• More transparency in MA plan marketing and operations to curb misleading practices and better inform patient choices.
• Expanded access to behavioral health care, including new network adequacy requirements covering substance use and mental health services.
• Efforts to reduce inappropriate coverage denials, ensuring patients receive the benefits promised in their plans.

Physician groups, including the California Medical Association (CMA), have largely supported the reforms, especially those addressing administrative burdens and enhancing patient protections. The rule takes effect for the 2026 plan year and is part of CMS’s broader strategy to hold MA plans accountable for delivering high-quality, equitable care.