The Medicare Payment Advisory Commission (MedPAC) released its June 2025 Report to Congress (PDF), evaluating improvements to Medicare payment systems and issues affecting the Medicare program across seven chapters.
For physicians, MedPAC recommended that for 2026, Congress should replace the existing bifurcated update based on participation in alternative payment models with a single update equal to the Medicare Economic Index minus 1 percentage point. The commission also recommended that Congress improve the accuracy of Medicare’s relative payment rates for clinician services by collecting and using timely data that reflects the costs of delivering care.
The commission included several chapters analyzing different aspects of Medicare Advantage (MA). This included an analysis of home health care use among MA enrollees using combined encounter and home health assessment data to better understand utilization. The commission dug in further on supplemental benefits in MA by reviewing trends in spending, types of benefits offered, and a discussion on how MA encounter data may be used to measure utilization of MA supplemental benefits. MedPAC also detailed the current policy impacts to stand-alone prescription drug plans and MA Prescription Drug plans.
Lastly, the commission included a chapter on cost sharing for outpatient services at critical access hospitals (CAHs). Within this chapter, MedPAC recommended that Traditional Medicare beneficiary cost sharing for outpatient services provided at CAHs be based on each hospital’s Medicare payment amount instead of on the hospital’s charges. This recommendation would limit co-insurance for outpatient service provided by CAHs to 20% of the payment amount for services that require cost sharing and implement a cap on CAH outpatient coinsurance equal to the inpatient deductible.