2026 Medicare Plan Finder Enhancements: Key Changes and Improvements
Relevant to: PDP, OEC, Drug Pricing, PACE, Part D
Each week, we scan the latest CMS memos to find the most important ones that apply for PACE programs. Below is a summary of what you need to know.
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Introduction
As we approach Contract Year 2026, the Centers for Medicare & Medicaid Services (CMS) have rolled out several enhancements to the Medicare Plan Finder and the Health Plan Management System. These updates aim to improve user experience in areas such as pharmacy finder usability, online enrollment, and drug pricing previews. For prospective and current Medicare Advantage and Prescription Drug Plans, these changes underscore the strategic direction towards enhancing efficiency and clarity in plan management and enrollment processes.
Key Dates and Deadlines
- Date of Memo: May 27, 2025
- Implementation of Race and Ethnicity Fields Removal: January 1, 2026
- New Enrollee Assistance Fields and DataCD Accessibility Option Effective: January 1, 2026
- Part D Pricing File Submission Changes Effective for Initial Price Applicability Year: 2026
- OEC Enrollment Form Changes Effective: January 1, 2026
PACE Compliance
This memo is relevant to PACE programs because it addresses several enhancements to the Medicare Plan Finder (MPF), the Health Plan Management System (HPMS), and other modules that may affect how PACE organizations submit and manage their information, especially in the context of Part D pricing and enrollment.
PACE organizations must adhere to the following compliance requirements related to the enhancements:
– Attention must be given to handling the enrollment form changes effective from January 1, 2026, such as the removal of race and ethnicity questions and the introduction of new enrollee assistance fields.
– If relying on the Online Enrollment Center (OEC) management module, PACE organizations should note the changes to file download record layout, including the removal of fields and renaming of certain fields, such as changing “ApplicantGender” to “ApplicantSex”. Additionally, the DataCD value must be acknowledged for accessibility format.
– With the introduction of maximum fair prices (MFP) for selected drugs, it is crucial for organizations to ensure their pricing files include all selected drugs to avoid validation errors. This includes conforming to the “Missing Pricing for Selected Drugs” and “Unit Cost Exceeds Maximum Fair Price” validations.
– The PACE organizations should be aware of the error message implementation when a user attempts to proceed without selecting a state on the SPAP and PACE pages, emphasizing the importance of correct state selection in submissions.
– Plans must utilize the Bid Pricing Tool (BPT) to ensure compliance with the new pricing structures, submissions, and validations to avoid suppression on the Medicare Plan Finder.
Required Actions
1. Familiarize yourself with the enhancements planned for the Medicare Plan Finder and HPMS modules for Contract Year 2026. This includes updates to plan benefit display, pricing file submissions, and online enrollment center management.
2. Prepare to implement the new Medicare Prescription Payment Plan cost preview functionalities, updated enrollment forms, and the modifications for handling insulin drug cost sharing according to the Inflation Reduction Act.
3. Review and adjust your organization’s systems to accommodate the changes in file layout for Part D pricing file submissions and ensure compliance with the validation changes and new fields related to drug dispensing fees.
FAQs
- What are the key enhancements planned for the Medicare Plan Finder in 2026?
- How will the removal of race and ethnicity questions impact enrollments in 2026?
- What changes are being made to the Part D Pricing File Submission Module?
- What are the new features added to the Online Enrollment Center Management Module?
- How will the Inflation Reduction Act affect insulin drug cost sharing for Medicare?
