How to Win in Medicare Advantage 2026

Welcome back to the Value-Based Care Advisory podcast! In this episode, host Alex Yarijanian delves into the significant updates and strategies for 2026 in the Medicare Advantage space. He covers essential news and policy changes, including a 5% increase in Medicare payment rates, the scaling back of supplemental benefits, and the permanence of telehealth for behavioral health. Alex also discusses updates to the Medicare physician fee schedule, redesigned enrollment forms, new health risk assessment requirements, and the transition to a new risk adjustment model. Learn how these changes will impact care delivery, compliance, and strategy, and discover what it takes to thrive in this evolving landscape. Tune in and prepare for the Medicare Advantage showdown of 2026!

00:00 Welcome to the Value-Based Care Advisory Podcast

00:15 2026 Medicare Advantage Showdown Overview

01:24 Key Policy Updates for 2026

03:11 Telehealth and Virtual Care Innovations

04:39 Enrollment and Form Updates

06:12 Risk Adjustment and Star Ratings

08:52 Strategic Focus Areas for 2026

14:44 Final Thoughts and Conclusion

Takeaways:

• The 2026 Medicare Advantage payments are set to increase by approximately 5%, contributing an excess of $25 billion to the plans.
• Significant changes have been initiated regarding supplemental benefits, particularly affecting non-medical services like transportation and meals.
• Telehealth services for behavioral health will become a permanent fixture, with no geographic restrictions imposed from 2026 onward.
• New billing codes will be introduced for digital therapeutics and remote monitoring, enhancing the infrastructure for virtual care delivery.
• The upcoming risk adjustment model will utilize the full 2024 CMS HCC risk model, significantly impacting financial strategies for Medicare Advantage organizations.
• Plans must prioritize compliance and operational integrity to navigate the complexities of changing regulations and maintain their competitive edge.