CMS Rate Increases and the AMA’s Response
- James Quest
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CMS announced a rate increase for insurance companies, prompting criticism from the AMA and physicians, who argue that it neglects provider reimbursement issues and jeopardizes patient care access. The debate underscores ongoing tensions in the healthcare ecosystem, with providers calling for reforms that prioritize medical professionals and patient outcomes over insurance profits.
The Centers for Medicare & Medicaid Services (CMS) has proposed a 4.3% increase in payments to Medicare Advantage (MA) plans for 2026, translating to an additional $21 billion for insurers. This proposal includes a 2.2% rise in the average benchmark payment to MA plans, with the remainder attributed to insurers’ coding for member health statuses.
In contrast, physicians are facing a 2.83% reduction in Medicare payments for 2025, marking the fifth consecutive year of such cuts. The American Medical Association (AMA) has expressed strong opposition to the proposed MA payment increase, emphasizing the financial challenges that ongoing physician payment cuts pose to patient access to care.
The AMA is advocating for reforms to the Medicare payment system to ensure fair compensation for healthcare providers, aiming to maintain patient access to high-quality care.
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