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Health and Human Services Department, Centers for Medicare & Medicaid Services

Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program

Published April 6, 2026. Takes effect June 1, 2026, printed at 91 FR 17384, amending 42 CFR 422, 42 CFR 423. 226,511 words.

In plain English

This sets rules for Medicare plans run by private firms. It covers 2027.

Read it at the Federal Register →

What the Rule Says It Does

This final rule revises the Medicare Advantage (Part C), Medicare Prescription Drug Benefit (Part D), and Medicare cost plan regulations to implement changes related to Star Ratings, marketing and communications, drug coverage, enrollment processes, special needs plans, and other programmatic areas.

This is the rule's own summary, as the Federal Register prints it.

The Orders It Names

The rule names these orders itself. What it does about them is a reading, and none is recorded here.

On the Face of the Rule

As filed

[Federal Register Volume 91, Number 65 (Monday, April 6, 2026)] [Rules and Regulations] [Pages 17384-17602] From the Federal Register Online via the Government Publishing Office [www.gpo.gov] [FR Doc No: 2026-06600]

Vol. 91

Monday,

No. 65

April 6, 2026

Part III

Department of Health and Human Services

Centers for Medicare & Medicaid Services

42 CFR Parts 422 and 423

Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program; Final Rule

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 422 and 423

[CMS-4208-F3 and CMS-4212-F] RIN 0938-AV40 and 0938-AV63

Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program

AGENCY

Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).

ACTION

Final rule.

DATES

Effective date: These regulations are effective June 1, 2026.

Applicability date: These regulations are applicable to coverage beginning January 1, 2027.

FOR FURTHER INFORMATION CONTACT

Kristy Nishimoto, (206) 615-2367--General Questions and Beneficiary Enrollment Issues. Naseem Tarmohamed, (410) 786-0814--Part C and Cost Plan Issues. Lucia Patrone, (410) 786-8621--Part D Issues. Alissa Gross, (410) 786-1120--Parts C and D Payment Issues. Sara Klotz, (410) 786-1984--D-SNP Issues. Beckie Peyton, (410) 786-1572--Manufacturer Discount Program Issues. [email protected]--Parts C and D Star Ratings Issues. [email protected]--RFI on Future Directions in Medicare Advantage [email protected]--Part D Program Integrity Issues

The fields the Federal Register prints at the head of the rule, quoted as printed. Its summary is quoted above.

Why the Agency Says It Is Doing This

SUPPLEMENTARY INFORMATION

I. Executive Summary

A. Purpose

The primary purpose of this rule is to amend the regulations for the Medicare Advantage (Part C) program, Medicare Prescription Drug Benefit (Part D) program, and Medicare cost plan program. This rule includes a number of changes that would improve these programs for contract year 2027 as well as codify existing subregulatory guidance.

We note that, as with previous rules, the new marketing and communications policies in this rule are applicable for all contract year 2027 marketing and communications, beginning October 1, 2026.

The passage that opens the rule's preamble, where the agency sets out what it is doing and on what authority. Every heading that follows it is listed below.

What the Rule Contains

Every heading the Federal Register prints in this rule, in the order it prints them. 76 headings, 226,511 words in all.

  1. AGENCYOn its face · 15 words
  2. ACTIONOn its face · 3 words
  3. SUMMARYOn its face · 42 words
  4. DATESOn its face · 22 words
  5. FOR FURTHER INFORMATION CONTACTOn its face · 71 words
  6. SUPPLEMENTARY INFORMATIONPreamble · 2 words
  7. I. Executive SummaryPreamble · 3 words
  8. A. PurposePreamble · 85 words
  9. B. Summary of the Key ProvisionsPreamble · 6 words
  10. 1. Medicare Part D RedesignPreamble · 940 words
  11. C. Summary of Costs and BenefitsPreamble · 16 words
  12. D. Publication of the Proposed Rule, Responding to Public Comments, Finalization of Proposed Provisions, and Requests for InformationPreamble · 244 words
  13. E. ConclusionPreamble · 156 words
  14. A. Medicare Part D RedesignPreamble · 5 words
  15. 1. BackgroundPreamble · 15,781 words
  16. B. Medicare Coverage Gap Discount ProgramPreamble · 474 words
  17. C. Medicare Part D Manufacturer Discount ProgramPreamble · 7 words
  18. 1. BackgroundPreamble · 22,993 words
  19. D. Definition of Creditable CoveragePreamble · 3,817 words
  20. E. Outlier Prescriber CriteriaPreamble · 4 words
  21. 1. BackgroundPreamble · 2,610 words
  22. F. Reopening and Payment AppealsPreamble · 2,402 words
  23. III. Enhancements to the Medicare Advantage and Medicare Prescription Drug Benefit ProgramsPreamble · 12 words
  24. A. Revise List of Non-Allowable Special Supplemental Benefits for the Chronically Ill (SSBCI) (Sec. 422.102)Preamble · 5,253 words
  25. B. Use and Release of Risk Adjustment DataPreamble · 7,052 words
  26. C. Strengthened Documentation Standards for Part D Plan SponsorsPreamble · 9 words
  27. 1. Background of Part D Coverage Determinations and Point-of-Sale (POS) Claim AdjudicationsPreamble · 34,017 words
  28. I. Appeals Process for Part D Program Integrity Prescription Drug Event Record Review AuditsPreamble · 14 words
  29. 1. BackgroundPreamble · 2,988 words
  30. J. Prescription Drug Event Submission Timeliness Requirements (Sec. 423.325)Preamble · 9 words
  31. 1. BackgroundPreamble · 10,673 words
  32. 2. The Administration of Supplemental BenefitsPreamble · 2,240 words
  33. 4. AccessPreamble · 2,172 words
  34. 6. Marketing Supplemental BenefitsPreamble · 5,885 words
  35. A. IntroductionPreamble · 19,832 words
  36. C. Streamlining the Methodology, Further Incentivizing Quality Improvement, and Suggestions for New MeasuresPreamble · 5,580 words
  37. F. Impact of Proposed and Finalized ChangesPreamble · 1,186 words
  38. A. Model of Care (MOC) Off-Cycle Submission Window (42 CFR 422.101)Preamble · 1,229 words
  39. B. Passive Enrollment by CMS (Sec. 422.60)Preamble · 16,805 words
  40. D. Contract Modifications for D-SNPs Following State Medicaid Agency Contract Termination (Sec. 422.510)Preamble · 8,922 words
  41. VII. Reducing Regulatory Burden and Costs in Accordance With Executive Order (E.O.) 14192Preamble · 58 words
  42. A. Exclusion of Account-Based Medical Plans From Entities Required To Make Disclosures of Creditable Coverage (Sec. 423.56)Preamble · 1,790 words
  43. B. Deregulate Sec. 422.102(e) Pathway for Certain D-SNPs To Offer Supplemental Benefits (Sec. 422.102)Preamble · 3,249 words
  44. D. Revisions to Ensuring Equitable Access to Medicare Advantage (MA) Services (Sec. 422.112(a)(8))Preamble · 824 words
  45. E. Rescinding the Annual Health Equity Analysis of Utilization Management Policies and Procedures (Sec. 422.137(c)(5), (d)(6) and (d)(7))Preamble · 2,048 words
  46. F. Rescinding the Quality Improvement Program Health Disparities Requirement (Sec. 422.152(a)(5))Preamble · 864 words
  47. G. Deregulate Special Rule for Non-Compliant D-SNPs (Sec. 422.752)Preamble · 419 words
  48. H. Waiver of Part D Customer Call Center Hours for All Regions Served by LI NET (Sec. 423.2536)Preamble · 988 words
  49. VIII. Request for Information on Future Directions in Medicare Advantage (Risk Adjustment and Quality Bonus Payments)Preamble · 16 words
  50. A. IntroductionPreamble · 816 words
  51. B. Risk AdjustmentPreamble · 3 words
  52. 1. BackgroundPreamble · 1,420 words
  53. C. Quality Bonus Payments in Medicare AdvantagePreamble · 813 words
  54. D. Well-Being and NutritionPreamble · 222 words
  55. IX. Technical Changes to Terminology in Risk Adjustment and in Payments to Sponsors of Retiree Prescription Drug PlansPreamble · 264 words
  56. X. Collection of Information RequirementsPreamble · 335 words
  57. A. Wage DataPreamble · 317 words
  58. B. Information Collection Requirements (ICRs)Preamble · 4,384 words
  59. C. Summary of Information Collection Requirements and Associated BurdenPreamble · 9 words
  60. BILLING CODE PPreamble · 7 words
  61. BILLING CODE CPreamble · 3 words
  62. XI. Regulatory Impact AnalysisPreamble · 4 words
  63. A. Statement of NeedPreamble · 319 words
  64. B. Overall Impact AnalysisPreamble · 270 words
  65. C. Detailed Economic AnalysisPreamble · 2,439 words
  66. b. Specialty-Tier Maximum Allowable Cost Sharing (Sec. 423.104(d)(2)(iv)(D))Preamble · 4,491 words
  67. D. Alternatives ConsideredPreamble · 353 words
  68. E. Regulatory Review CostsPreamble · 283 words
  69. F. Accounting Statement and TablePreamble · 60 words
  70. G. Impact on Small Businesses--Regulatory Flexibility Analysis (RFA)Preamble · 1,891 words
  71. H. Unfunded Mandates Reform Act (UMRA)Preamble · 145 words
  72. I. FederalismPreamble · 68 words
  73. J. Executive Order (E.O.) 14192, “Unleashing Prosperity Through Deregulation”Preamble · 95 words
  74. K. ConclusionPreamble · 98 words
  75. List of SubjectsRegulatory text · 14,764 words
  76. Subpart AA--Medicare Part D Manufacturer Discount ProgramRegulatory text · 8,663 words

The Rest of the Text

This rule runs to 226,511 words. The rest of it is set out over 14 pages, split at the rule's own headings so that no heading is parted from the words printed under it.

How to cite this
  1. The rule itself

    Health and Human Services Department, Centers for Medicare & Medicaid Services, “Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program,” 91 FR 17384 (April 6, 2026). Effective June 1, 2026.
    https://www.federalregister.gov/documents/2026/04/06/2026-06600/medicare-program-contract-year-2027-and-certain-contract-year-2026-policy-and-technical-changes-to

  2. This page

    “Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program,” a final rule naming an order indexed here. Read the Mandate, https://readthemandate.org/rules/rule-2026-06600/ (retrieved October 10, 2026).

Cite the document when the claim is about what the document says. Cite this page when the indexing, the wording or the record of what has happened is what is being relied on.

How This Rule Is Set Out

Federal Register documents are United States government works and are not under copyright, so the rule is here whole rather than cut to an excerpt. It is split at the headings the Register itself prints: the line it is filed under, the captioned fields on its face, the preamble where the agency says what it is doing and why, and the amendments to the Code of Federal Regulations. No passage is shortened. This rule is long enough that its text is set out over 14 pages rather than one.

Two things the Register prints are not reproduced: the running head it repeats at every page break, and the tables it sets as pictures rather than as words. Its own marker for one of those tables, [GRAPHIC] [TIFF OMITTED], is left standing where the table was, so a reader can see that something is there and follow the link to the page it is on.

A heading with nothing quoted under it is one the rule prints on its own, with the words that follow it set under the headings beneath.