WASHINGTON, D.C. — The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule aimed at bolstering protections, enhancing access to care, and improving transparency for Medicare beneficiaries enrolled in Medicare Advantage (MA) and Medicare Part D prescription drug programs. The proposed Contract Year (CY) 2026 rule is part of the agency’s broader efforts to hold MA and Part D plans accountable for delivering high-quality coverage and reducing barriers to care.
Key Proposed Changes
The proposed rule introduces significant changes, including expanding coverage of anti-obesity medications under Medicare Part D, addressing issues with prior authorization practices in Medicare Advantage, and updating consumer tools to promote informed decision-making. These measures seek to ensure that individuals with Medicare receive the care and medications they need in a timely and effective manner.
Expanding Access to Anti-Obesity Medications
One of the most noteworthy aspects of the proposal is the reinterpretation of the statute governing Medicare Part D to include coverage of anti-obesity medications for the treatment of obesity. This change aligns with the prevailing medical consensus that obesity is a disease requiring medical intervention. Should this rule be finalized, Medicaid programs would also be required to cover these medications, broadening access to treatments that could significantly improve the health and quality of life for millions of Americans affected by obesity.
HHS Secretary Xavier Becerra underscored the potential impact of this change, stating, “Our loved ones with Medicare deserve care that puts their interests first. HHS is proposing to improve transparency, accountability, and consumer protections in Medicare Advantage and Part D plans so that everyone receives high-quality care.” He also emphasized the administration’s commitment to removing barriers to necessary care and medications.
Improved Consumer Tools on Medicare Plan Finder
The rule proposes enhancements to Medicare Plan Finder, an online tool designed to help beneficiaries compare Medicare options and coverage plans. Under the new proposal, Medicare Advantage organizations would be required to provide their full provider directory to CMS, enabling a more personalized and comprehensive user experience. This updated functionality would empower individuals with Medicare and their caregivers to more easily compare provider availability across multiple MA plans.
CMS Administrator Chiquita Brooks-LaSure highlighted the importance of these changes, saying, “This proposed rule continues to build on this work by expanding access to anti-obesity medications for people with Medicare and Medicaid, further addressing prior authorization concerns in Medicare Advantage, and promoting informed choice and transparency by requiring Medicare Advantage plans to share provider directory information on Medicare Plan Finder.”
Addressing Barriers to Access in MA Plans
CMS also seeks to address longstanding concerns regarding prior authorization in Medicare Advantage plans. Current data reveal that many claims initially denied by MA plans are overturned upon appeal, with 80% of decisions reversed when brought before the plan. However, fewer than 4% of denied claims are appealed, suggesting that many beneficiaries may not be receiving the care they are entitled to. The proposed rule is designed to reduce these barriers through changes to utilization management practices.
CMS Deputy Administrator and Director of the Center for Medicare Meena Seshamani, M.D., Ph.D., stated, “We continue to hear from people enrolled in Medicare Advantage who are having difficulty accessing the care they need and are entitled to, and CMS remains focused on removing these barriers.”
Furthermore, the rule aims to place guardrails on the use of artificial intelligence (AI) in care decisions, ensuring that beneficiaries have access to necessary health services without undue delays or denials influenced by automated systems.
Oversight and Consumer Protections
To protect consumers, CMS proposes increased oversight of Medicare Advantage advertisements, building on previous measures to address deceptive and misleading marketing practices. Since 2023, CMS has denied over 1,500 non-compliant TV ad submissions, highlighting the agency’s commitment to protecting beneficiaries from predatory behavior.
The rule also includes updates to the Medical Loss Ratio (MLR) regulations for MA and Part D plans, enhancing the transparency of data reported by plans. These updates are expected to provide policymakers with more detailed insights into plan spending and operations, paving the way for further reforms.
Commitment to Health Equity and Care Access
The proposed rule reflects the Biden-Harris Administration’s broader objectives to promote health equity and sustainable access to care for all Americans. By expanding the organ donor pool, removing unnecessary barriers to medications, and ensuring beneficiaries can make well-informed choices about their care, the administration continues to build on its efforts to enhance the Medicare program.
“These policies showcase our commitment to ensuring that all seniors and people with disabilities enrolled in Medicare receive the care they deserve,” said Brooks-LaSure. “Whether it’s improving access to medications, addressing prior authorization challenges, or providing better tools for navigating the system, these proposed changes ensure that consumers remain at the center of the system.”
The Medicare Part D and Medicare Advantage programs are poised for substantive improvements under the CY 2026 rule, which is designed to strengthen consumer protections, improve care delivery, and enhance the overall experience for beneficiaries. Public comments on the proposed updates will be taken into consideration as CMS works to finalize the rule.
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