The Regulator

Stand-alone Medicare drug plan premiums are projected to rise 50%, from $34 to $51 a month, after CMS ended its premium stabilization demonstration, and open enrollment closes December 7. The Centers for Medicare & Medicaid Services (CMS) said in its 2027 Part D bid announcement that it will discontinue the Part D Premium Stabilization Demonstration at the end of 2026, with the national average monthly bid at $296.05 and the base beneficiary premium at $41.33. The Kaiser Family Foundation (KFF), an independent health policy group, reported October 30 that the average enrollment-weighted premium for stand-alone prescription drug plans (PDPs) rises from $34 to $51 if enrollees keep their current plans, and that no zero-premium PDPs exist in 2027. Who it hits: more than 4 million people now in zero-premium PDPs, plus anyone in a plan with the new deductible, which KFF puts at an average of $643, up from $540. So what: KFF says people who switch to a lower-premium plan can avoid most of the increase, and the plan comparison that decides it must be done by December 7. Confidence: High on CMS’s demonstration end and bid figures; Med on the $51 average, which is KFF’s projection from June enrollment, not a CMS figure. Sources: CMS Part D 2027 bid amount fact sheet. Supplemental analysis: KFF release on 2027 PDP premiums.

UPDATE: CVS sues CMS over 2027 Medicare Advantage star ratings and puts the cost at $2 billion in 2028 payments. CVS Health, parent of the insurer Aetna, filed suit October 26 in the U.S. District Court for the Southern District of Georgia, challenging 28 rating measures it says CMS adopted without notice-and-comment rulemaking. Reporting says 43 contracts would have scored at least half a star higher without those measures, and the share of its 4.2 million Medicare Advantage members in plans rated four stars or above fell from 84% to 67%. Centene, a Medicaid and Medicare managed-care insurer, sued October 22 in the same court over 17 measures and put its 2028 effect at about $448 million. Alignment Healthcare, which we covered October 16, sued October 9. Who it hits: insurers whose quality bonus payments and rebates track star ratings, and the members in those plans. So what: no court has ruled on the 2027 suits, and the Georgia court earlier ruled for Clover Health on 20 measures, which the government has appealed. Confidence: Med. We could not open the complaints, so the figures rest on company-reported claims in news coverage. Sources: Healthcare Dive report on the CVS suit, which links the complaint, Becker’s Payer report on the Centene suit.

UPDATE: A second trade group sues to block the CMS freeze on new ACA brokers, days before open enrollment began. Health Agents for America, which represents more than 1,000 independent agents, sued HHS and CMS in federal court in Maryland, as the National Association of Benefits and Insurance Professionals did earlier in October. The September interim final rule bars agents and brokers not already registered with the exchanges from helping consumers enroll for 2027, with the freeze running until February and no public comment period. The plaintiffs say CMS ignored harm to brokers and consumers and exceeded its authority, and ask for a court order before open enrollment, which began November 1 in most states. Who it hits: new agents and the consumers who rely on them. So what: CMS says most improper enrollments, such as unauthorized plan switches, trace to new brokers, and the reporting gives no count of affected brokers or an enrollment estimate. Confidence: Med. We could not open the complaint. Sources: Healthcare Dive report on the suit, which links the complaint, Healthcare Dive report on the first suit.

CMS holds its second 2026 public meeting today on new billing codes for supplies and devices, with written comments due by November 4. The Healthcare Common Procedure Coding System (HCPCS) Level II meeting runs November 2 in Baltimore and virtually, with a virtual overflow day November 3. CMS discusses preliminary coding, Medicare benefit category and payment determinations for requests, most of them non-drug and non-biological products. Who it hits: manufacturers and suppliers seeking a billing code, and the practices that will bill under it. So what: CMS says final decisions are not made at the meeting, and the page does not give an issue date or the effective date of any new code. The page also lists two comment deadlines, November 4 and the date each item is discussed, so applicants should confirm. Confidence: High on the schedule; Low on timing of decisions. Source: CMS HCPCS public meetings page.