Medicare Payment Advisory Commission (MedPAC)
In its June 2026 report to congress, the Medicare Payment Advisory Commission (MedPAC), the independent government agency that advises Congress on Medicare policy, examines a range of issues affecting Medicare beneficiaries, provider payments, and Medicare program spending. Several findings are of particular interest to Medicare beneficiaries and advocates, including MedPAC’s ongoing concerns about excess payments to Medicare Advantage plans, its assessment that most beneficiaries continue to have adequate access to physician services, and its recommendations for improving the accuracy and sustainability of Medicare payment policies. Key findings from the report are highlighted below.
- Medicare Advantage coding and payments: MedPAC continues to express concern that Medicare Advantage plans receive higher payments because of differences in coding intensity and risk-score growth compared with traditional Medicare, raising questions about program spending and payment accuracy. MedPac estimates that the Medicare program, in 2026, will spend 14 percent or $76 billion more for MA enrollees.
- Complexity of Medicare Enrollment:highlights the importance of providing beneficiaries with clear, accessible, and unbiased information when making Medicare enrollment decisions. The Commission notes that beneficiaries must navigate increasingly complex choices among traditional Medicare, Medicare Advantage, Part D prescription drug plans, and supplemental coverage options, each with different costs, benefits, provider networks, and utilization management requirements. The report finds that “[s]ome beneficiaries have expressed confusion regarding enrolling in Medicare, including having insufficient information”.
- Medicare physician payment reform: The Commission revisits concerns about the long-term adequacy and stability of physician payment updates and continues to support reforms that would better align payment updates with practice cost growth while improving the accuracy of relative payment rates.
- Beneficiary access to care: MedPAC reports that Medicare beneficiaries generally continue to maintain access to clinician services, although access challenges remain in some areas, particularly for primary care and in certain underserved communities.
- Medicare spending and program integrity: The report examines areas where Medicare payment policy may create incentives for excess spending and identifies opportunities to improve oversight, payment accuracy, and value for beneficiaries and taxpayers. The report notes that the physician fee schedule currently relies on surveys of small, self-selected clinician groups who may have financial incentives to overstate their effort and that inaccurate valuations distort payments across thousands of services.
- Medicare Advantage oversight: The Commission highlights ongoing concerns about plan payment, coding practices, and the need for greater accountability to ensure that Medicare Advantage payments accurately reflect beneficiary health status and program goals. The report also notes that Medicare Advantage had longer than average hospital stays compared to FFS beneficiaries. The report found that the average stay was 11.2% longer.
- Medicare’s fiscal sustainability: Consistent with prior reports, MedPAC emphasizes the importance of improving payment accuracy and program efficiency as Medicare enrollment and spending continue to grow.
Medicaid and CHIP Payment and Access Commission (MACPAC)
In its June 2026 report to Congress, the Medicaid and CHIP Payment and Access Commission (MACPAC), the independent agency that advises Congress on Medicaid and CHIP policy, evaluates beneficiary access to care, Medicaid program administration, and federal and state oversight of the program. Several findings are particularly noteworthy for beneficiaries and advocates, including MACPAC’s recommendations to closely monitor the effects of Medicaid work requirements on coverage, strengthen oversight of AI-assisted prior authorization decisions, and improve accountability in Medicaid managed care. Key findings from the report are highlighted below.
- Community engagement (CE): MACPAC recommends a transparent federal monitoring and evaluation framework as states implement new Medicaid community engagement requirements, emphasizing the need to track coverage losses, enrollment changes, and administrative barriers. The creation of a federal monitoring plan should provide insight into “how such policies [CE] affect eligibility and enrollment.” The goal is to monitor if the CE program causes substantial disenrollment of eligible individuals. MACPAC recommends that HHS use its existing evaluation expertise and federal data sources from previous programs such as Section 1115 to assess whether Medicaid community engagement requirements are achieving their stated goals, including examining differences in outcomes across states and drawing on stakeholder input. These reports need to be published in a timely manner.
- Prior authorization and AI: The Commission recommends stronger oversight and transparency regarding the use of automation and artificial intelligence in Medicaid prior authorization, including ensuring that adverse coverage decisions are not made by automated systems alone.
- Managed care accountability: MACPAC recommends additional tools and guidance to help states better monitor Medicaid managed care plans and improve the usability of plan performance data.
June 25, 2026 – A. Flashner