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April 7, 2025

NOTE: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties Announcement of Calendar Year (CY) 2026 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies In accordance with section 1853(b)(1) of the Social Security Act (“the Act”), we are notifying you of the annual capitation rate for each Medicare Advantage (MA) payment area for CY 2026 and the risk and other factors to be used in adjusting such rates. In response to our request for comments on the Advance Notice of Methodological Changes for CY 2026 MA Capitation Rates and Part C and Part D Payment Policies (CY 2026 Advance Notice), published on January 10, 2025, CMS received submissions from professional organizations, MA and Part D sponsors, advocacy groups, physicians, pharmaceutical manufacturers, pharmacy benefit managers, pharmacies, and interested persons. The Announcement of CY 2026 MA Capitation Rates and Part C and Part D Payment Policies (CY 2026 Rate Announcement) describes and responds to all of the substantive comments received. After considering all comments received, we are finalizing policies in the CY 2026 Rate Announcement. The capitation rate tables for CY 2026 and supporting data are posted on the CMS website at https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Ratebooks-and- Supporting-Data.html. The statutory component of the regional benchmarks, qualifying counties, and each county’s applicable percentage are also posted on this section of the CMS website. Attachment I of the CY 2026 Rate Announcement shows the final estimates of the National Per Capita MA Growth Percentage for CY 2026 and the National Medicare Fee-for-Service (FFS) Growth Percentage for CY 2026, used to calculate the CY 2026 capitation rates. As discussed in Attachment I, the final estimate of the National Per Capita MA Growth Percentage for combined aged and disabled beneficiaries is 10.72 percent, and the final estimate of the FFS Growth Percentage is 8.81 percent. Attachment II provides a set of tables that summarizes the key Medicare assumptions used in the calculation of the growth percentages. Section 1853(b)(4) of the Act requires CMS to release county specific per capita FFS expenditure information on an annual basis, beginning with March 1, 2001. In accordance with this requirement, FFS data for CY 2023 were posted on the above website with the CY 2026 Advance Notice.