The Centers for Medicare and Medicaid Services (CMS), the federal agency overseeing two of the nation’s largest public health insurance programs, has released several significant policy and program updates for late 2025 and the upcoming 2026 fiscal year. These developments impact healthcare providers, insurers, and over 150 million Americans enrolled in Medicare and Medicaid.
CMS Finalizes the 2026 Medicare Physician Fee Schedule
The most prominent update from the Centers for Medicare and Medicaid Services is the release of the 2026 Medicare Physician Fee Schedule (PFS) final rule. The rule includes payment adjustments for physicians, specialists, and outpatient facilities under Medicare Part B.
The new payment model focuses on improving value-based care, reducing administrative burden, and expanding access to mental health and telehealth services. Physicians will see changes in reimbursement calculations, with an emphasis on preventive care and chronic-disease management.
Key takeaways from the new rule include:
- Expanded coverage for behavioral health telemedicine services.
- Additional incentives for primary-care providers who manage complex chronic conditions.
- A new payment structure for team-based care models, especially in rural and underserved communities.
These revisions reflect CMS’s continued goal of balancing cost efficiency with high-quality healthcare delivery.
Government Shutdown Causes Limited Service Disruptions
The ongoing federal funding lapse has partially affected CMS operations. While core Medicare and Medicaid benefits remain funded, several administrative and oversight functions have slowed. Claim reviews, certification surveys, and non-urgent audits have been temporarily reduced.
CMS has stated that it is maintaining essential services such as:
- Processing Medicare payments to hospitals and doctors.
- Handling Medicaid reimbursements for states.
- Managing critical beneficiary support functions.
However, the agency warned of potential delays in non-emergency claims and longer processing times for program approvals and updates. Beneficiaries and healthcare providers are advised to monitor official CMS communications for updates on resuming full services.
Stable Premiums for Medicare Advantage and Part D Plans in 2026
For beneficiaries enrolled in Medicare Advantage (MA) and Part D prescription-drug plans, CMS has confirmed that average premiums will remain stable for the 2026 plan year. Despite inflationary pressures, the agency reports that competition among insurers and stronger regulatory oversight have helped control costs.
In addition to stable premiums, beneficiaries can expect:
- Continued cap on insulin costs at $35 per month.
- Expanded coverage for vaccines at no out-of-pocket cost.
- Enhanced access to low-income subsidy programs for prescription drugs.
These efforts align with the Biden administration’s ongoing campaign to lower healthcare costs and improve affordability for seniors and low-income families.
New Rural Health Transformation Initiative
Recognizing the growing financial strain on rural hospitals and clinics, the Centers for Medicare and Medicaid Services has launched the Rural Health Transformation Program. This multi-billion-dollar initiative aims to redesign how healthcare is delivered in rural America, focusing on sustainability rather than short-term bailouts.
The program encourages rural hospitals to adopt innovative care models, such as community health partnerships, virtual-care networks, and value-based payment systems. Eligible states can apply for funding to support these pilot programs starting in early 2026.
This move is seen as a lifeline for rural facilities that have struggled with declining patient volumes and rising operational costs over the past decade.
CMS Expands Device Coverage and Modernizes Review Processes
In another landmark decision, CMS has finalized coverage for Medtronic’s Symplicity Spyral™ renal denervation system — a new therapy for patients with uncontrolled hypertension. The decision sets an important precedent for how CMS evaluates and approves innovative medical devices under Medicare.
CMS is also modernizing its National Coverage Determination (NCD) process to make reviews faster and more transparent. The agency plans to increase stakeholder engagement and streamline how evidence is evaluated for breakthrough medical technologies.
This updated process will help patients gain faster access to safe and effective treatments while ensuring that Medicare funds are used efficiently.
Funding and Oversight Plans Amid Fiscal Challenges
While CMS remains operational during the current funding uncertainty, the agency has released a contingency staffing plan to ensure critical services continue. Medicaid will remain fully funded through at least the first quarter of FY 2026, though state-level program monitoring and outreach initiatives may experience slowdowns.
CMS officials have emphasized that beneficiaries’ healthcare access will not be interrupted and that payments to providers will proceed as scheduled. Still, the agency acknowledges that prolonged budget negotiations could create future administrative challenges if not resolved soon.
What Beneficiaries and Providers Should Do Now
Healthcare providers, insurers, and beneficiaries are encouraged to:
- Review the 2026 PFS final rule to understand changes in reimbursement.
- Check their Medicare Advantage or Part D plan for premium and benefit updates.
- Follow official CMS announcements for telehealth claim processing updates.
- Monitor state Medicaid program adjustments due to federal funding constraints.
Staying proactive ensures both patients and providers remain informed about how evolving federal policies may affect coverage and care delivery.
Conclusion
The Centers for Medicare and Medicaid Services continues to drive major healthcare reforms across the nation — from stabilizing premiums to expanding telehealth and rural-care access. As CMS implements new policies for 2026, millions of Americans stand to benefit from improved affordability and innovation in care delivery.
Stay tuned to upcoming CMS updates, and feel free to share your thoughts below on how these changes could impact you or your community.