FOR IMMEDIATE RELEASE: April 9, 2025
Media Contact: Anika Thota, PNHP Policy & Communications Specialist, anika@pnhp.org
On April 7, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized a 5.06% increase in payments to Medicare Advantage (MA) plans for 2026—more than double the 2.23% increase originally proposed in February based on CMS’s own actuarial projections.
Physicians for a National Health Program (PNHP) strongly condemns the hike, which is the direct result of aggressive lobbying from health insurance corporations that demanded and secured billions of Medicare dollars at the expense of the American public.
“For the first time in our nation’s history, Congress has hired a licensed insurance broker to be in charge of Medicare,” said Dr. Ed Weisbart, PNHP’s national board secretary. “It should come as no surprise, then, that within less than one week of his being confirmed by the Senate, he authorized the single largest increase in payments to Medicare Advantage for more than a decade.”
Corporate MA insurers already receive an estimated $140 billion in annual overpayments, driven by upcoding, favorable selection, and manipulation of bonus payments—with patients and doctors ultimately paying the price.
Medical practitioners now spend an estimated 11 to 20 million hours every year navigating prior authorization requests from MA plans. These administrative barriers directly contribute to delayed care, with MA enrollees nearly twice as likely to report care delays compared to those in traditional Medicare. At the same time, over 11 million beneficiaries are trapped in narrow networks that exclude most physicians in their area. And despite promises of “affordability,” at least 7.3 million enrollees are underinsured, facing high out-of-pocket costs for needed care.
“This misuse of taxpayer dollars is all the more egregious in the face of how much harm these insurance corporations inflict on millions of seniors, people with disabilities, rural hospitals, and physicians and other clinicians across the United States,” said Dr. Weisbart.
Against this backdrop of widespread denial, restriction, and profiteering, CMS’s decision to raise payments even further is not just irresponsible—it’s dangerous. The 5.06% rate hike rewards an already failing and exploitative system, pouring billions more into plans that consistently underdeliver on access, equity, and care.
Physician leaders from PNHP are available for interviews to speak on the implications of this decision and the urgent need to end Medicare Advantage overpayments. Please contact PNHP Policy and Communications Specialist, Anika Thota at anika@pnhp.org for interview requests.
Physicians for a National Health Program (pnhp.org) is a nonprofit research and education organization whose more than 25,000 members support single-payer Medicare for All reform.