Charles Baker, VP, Compliance Solutions

President Trump’s executive order to freeze federal regulations has left the healthcare industry, particularly the Medicare Advantage (MA) program, in a state of uncertainty. The freeze, which is intended to align current and proposed rules with the administration’s priority of “reducing the regulatory burden on American businesses and citizens,” has the potential to change the landscape of the program as we know it. For MA plans, however, this may be cause for hope: during the first Trump administration, the industry benefited from an overall deregulatory trend, leading to significantly fewer enforcement actions, reduced civil monetary penalties, and less oversight.

Potential Impacts on Policy Implementation

Upon taking office, President Trump revoked 78 executive actions from the Biden administration, several of which were specific to the healthcare sector. Most notably, these initiatives were aimed at lowering drug costs through the Inflation Reduction Act, including capping generic drug prices for Medicare beneficiaries at $2.

Industry experts are closely monitoring the proposed Medicare Advantage Part D rules for 2026 and the advanced rate notice. These updates are intended to enhance payment accuracy and stabilize the program by tweaking risk models and increasing oversight of marketing and communication. However, the new administration is now reviewing these rules, and it’s unclear whether they’ll be implemented as proposed.

Adding to the complexity, the 2026 Advance Notice suggests a 4.33% increase in base payments for MA plans, translating to more than $21 billion in funding. This proposed boost is also under review, and the administration’s decision to accept, revise, or reject it will significantly impact plan revenue and future benefit design, as many plans rely on payment increases to enhance benefits for enrollees.

The freeze also affects the Contract Year 2025 Policy and Technical Changes to the Medicare Advantage Program, a policy with more than 1,600 public comments. Given the high volume of comments and recent litigation around risk adjustment, it’s clear that MA plans will have the opportunity to influence the program’s direction through advocacy and/or legal action.

Project 2025: Will It Harm or Help?

While the new administration has tried to distance itself from Project 2025, it could provide a framework to reshape the program given its authors argue for deregulating healthcare, including Medicare Advantage. Supporters say this deregulation will boost competition and lower costs, but critics worry it could mean less oversight and reduced access to care. If the government runs with these ideas, Medicare Advantage plans could see significant enrollment increases, shaking up market share and potentially changing member protections. Will Medicare Advantage become the default enrollment option for beneficiaries? Probably not, but it’s clear that this administration is pro MA, and plans should invest in running shoes to keep up with the potential explosive enrollment growth.

Enter HHS Secretary Nominee Robert F. Kennedy, Jr.

The outlook is even more clouded with Robert F. Kennedy, Jr., as the Secretary of Health and Human Services nominee. Kennedy has made clear that he wants more transparency and less influence from Big Pharma. This focus could mean closer scrutiny of MA plans’ drug pricing, drug plan negotiations, and transparency around utilization management and prior authorization practices. Given the Senate hearings related to sales and marketing transparency, in a rare bi-partisan effort, these initiatives seem to signal ongoing improvement in consumer protections when enrolling in MA plans. And, while his criticism of federal health agencies raises questions about oversight and enforcement, it’s clear that Kennedy has the potential to be a very MA-friendly secretary.

Kennedy has been public in supporting preventative care and addressing chronic diseases, which aligns with many MA plans’ goals for whole-person wellness, as well as current initiatives from CMS to improve quality of care. However, his unconventional views on treatments could challenge longstanding public health norms. Further, Kennedy has touted value-based payment models, which may accelerate how MA plans are reimbursed through risk adjustment models and quality bonus payments, such the Health Equity Index. In a 180 from the previous administration, all diversity, equity and inclusion (DEI) activities are under scrutiny, including the Health Equity Index bonus within the STAR rating system set to take effect in 2027.

Tips for Industry Players to Stay Ahead

  • Run all scenarios. Map out different “what-if” scenarios and adjust budgets for potential changes in payments or benefits. It’s key to understand any changes to risk adjustment models, STAR calculations, benefit structures and cost of care metrics.
  • Stay engaged with policymakers and build strong relationships with lawmakers
    • Team up with other MA players to make your voice is heard on key policies and advocate for stability and member-focused policies.
    • Participate in public comment periods and back your feedback with solid data.
    • Monitor new developments and craft quick responses to legislators and advocacy groups.
    • Use predictive models to see how potential changes could affect your bottom line
  • Focus on Your Members and Use the Right Data
    • Emphasize quality of care, such as managing chronic diseases to prevent hospital readmissions. Quality of care remains crucial for controlling costs, improving outcomes, and ensuring member satisfaction.
    • Use data tools to spot gaps in care and predict member needs.
    • Expand telehealth services to make care more accessible, especially in underserved areas.
    • Remain vigilant about customer care and retaining members.
  •  Talk With Your Members
    • Listen to member feedback with empathy, and factor it into decision-making.
    • Be upfront about any changes in benefits or costs and explain them clearly.
    • Use utilization data to tailor messaging to frequently used member services.
    • Build stronger ties with providers to align goals for better care and simplify referrals.

Turning Uncertainty Into Possibility

The freeze is a chance to rethink and improve current policies. By teaming up with policymakers and focusing on member experience, plans can adapt and thrive. While challenging, this period of change also holds the potential for positive transformation and growth in the Medicare Advantage program.

Contact ATTAC to prepare your Medicare Advantage plan to thrive in a fast-changing regulatory landscape. We’re nationally recognized as an expert in regulatory interpretation, design, and operation of effective compliance programs for Medicare, Medicaid and commercial health plans, PDPs, ACA plans, ACOs, IPAs, medical groups, dental and vision plans.