Summary of CMS Proposed Rule for Year 2026 Policy and Technical Changes to the MA Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and PACE Program (CMS-4208-P)

The Centers for Medicare & Medicaid Services (CMS) recently unveiled an extensive proposed rule under the designation CMS-4208-P, which aims to implement significant reforms across multiple Medicare programs. These include the Medicare Advantage (MA) Program, the Medicare Prescription Drug Benefit Program (Part D), the Medicare Cost Plan Program, and the Programs of All-Inclusive Care for the Elderly (PACE). The proposed changes are designed to address several key priorities, including enhancing beneficiary access to critical services, promoting equitable coverage, improving program integrity, and ensuring that these programs meet the evolving needs of Medicare enrollees. The proposed rule targets the 2026 contract year, reflecting the agency’s commitment to long-term, sustainable improvements in the quality and accessibility of care.