1What Happened
CMS issued a proposed rule on May 20, 2026 that would modify Medicaid state-directed payments and align payment levels more closely with Medicare rates. Separately, CMS is moving forward with a proposed prior authorization reform requiring insurers to respond to urgent drug requests within 24 hours and standard requests within 72 hours. Medicare Advantage payment rates to plans will increase an average of 5.06% in 2026, which may affect plan benefits and costs.
2The Detroit Angle
Many GM, Ford, and Stellantis retirees, as well as public sector workers, rely on Medicare Advantage plans for their supplemental coverage. The 5.06% funding increase sounds good — but it flows to plans, not directly to enrollees. Some plans may use it to maintain benefits; others may quietly trim them. The prior authorization reform is a win for anyone who has ever waited weeks on a drug coverage decision from their Medicare Advantage insurer.
3Janine's Take
This week, CMS made headlines with a proposed rule change affecting how Medicare Advantage insurers handle prior authorizations. If you've ever had to wait on approval for a prescription or procedure, help may be coming. The bigger takeaway? Medicare rules are in constant motion, and the Annual Enrollment Period is coming this fall. If you haven't reviewed your Medicare plan in the last year, now is exactly the right time to schedule a conversation.
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