CMS and Medicare Advantage: What’s Next for Publicly Traded and Local Plans?

The Centers for Medicare & Medicaid Services (CMS) is sharpening its focus on Medicare Advantage (MA) plans, with special attention on publicly traded insurers. Dr. Meena Seshamani, CMS Deputy Administrator and Director of the Center for Medicare, recently assured stakeholders that the agency will scrutinize big-name, publicly traded MA organizations, but what does this mean for smaller, regional plans?

With CMS’ attention squarely on large, publicly traded plans, how does the Trump Administration’s nominee to lead CMS, Dr. Mehmet Oz, factor in?  One local plan CEO reports to Rebellis that a recent discussion with Dr. Oz in Palm Beach, Fl. presented the opportunity to educate the nominee on issues important to local plans, which far outnumber publicly traded plans.  The CEO took the opportunity to explain how the challenges faced by smaller, local plans differ from the national market leaders and reported that the nominee was appreciative for the education.

Takeaways:

✅ Heightened CMS Oversight: Expect increased scrutiny of how large MA plans manage prior authorizations, provider networks, and denials of care.

✅ Regulatory Blind Spots? While CMS is laser-focused on big players, smaller and local plans may not be receiving the same level of attention—or understanding.

✅ Implications for the Industry: While national plans may invite scrutiny, local and regional plans must proactively advocate for their unique needs, ensuring their voices are heard in the evolving MA landscape.

At Rebellis Group, we work with both large and small MA organizations, helping them stay ahead of regulatory shifts and navigate CMS’s evolving policies.

The best way to stay ahead of CMS changes is by subscribing to Rebellis’ regulatory tracking service, which logs and analyzes HPMS memos, proposed and final rules. This service ensures your team remains informed with the latest updates, helping to drive compliance and operational success.

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