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Medicare Advantage just scored a massive win.
CMS announced a 5.06% payment increase for 2026, pumping billions more into private Medicare plans that now cover 33 million seniors.
But here’s the fascinating twist:
The same rule that increases payments also handcuffs these plans from their most controversial practice: reopening and denying previously approved hospital admissions.
Starting now, if an MA plan approves your hospital stay, they can’t change their mind later and stick you with the bill. Unless there’s fraud or obvious error, that approval is final.
This is huge. 🎯
For years, patients have been caught in a nightmare scenario. Plan approves admission. Patient gets treatment. Plan reviews again and says “actually, that wasn’t medically necessary.” Patient gets a crushing bill.
Not anymore.
CMS also mandated that when doctors request prior authorization, both the doctor AND patient must be notified of decisions. No more leaving providers in the dark while patients wonder why their care got delayed.
Plus, they created a special enrollment period for 2026. If you pick a plan because your doctor is listed as in-network, then discover they’re actually out-of-network, you can switch plans within 3 months. Finally, accountability for those notoriously inaccurate provider directories.
The timing is critical. With 67% of MA plans charging zero premiums beyond Part B, they’re incredibly attractive to seniors on fixed incomes. But attraction without protection is dangerous.
This represents a fundamental shift in Medicare Advantage philosophy: more money, but with strings attached that actually protect patients.
The question now: Will a 5% payment bump be enough to keep plans profitable while forcing them to actually honor their coverage decisions?
We’re about to find out.
♻️ Repost if Medicare Advantage needs more oversight, not just more money.
👉 Follow me, Jonathan Govette, for real-time updates on healthcare technology and business news. LinkedIn Profile: https://www.linkedin.com/in/jonathangovette/
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
