The Medicare Payment Advisory Commission (MedPAC) released its March 2025 report to Congress on March 14, which evaluates Medicare payment adequacy and makes policy recommendations for 2026. MedPAC is an independent agency that advises Congress on Medicare policy, including provider payments. While it does not set payment rates, its recommendations often influence future policy decisions.

The following are items relevant to radiation oncology.

Physician and other health professional services (Chapter 4)
In the Report, MedPAC highlights concerns about the sustainability of physician payments under Medicare, especially because of rising input costs. Under current law, the payment rates for 2026 will increase by 0.25% for clinicians not in an advanced alternative payment model (0.75% for those that are), but cost increases are projected to be 2.3%. Therefore, the Commission is recommending that, for 2026, Congress should replace current law updates to Medicare payment rates with a single update equal to the projected increase in the Medicare Economic Indes minus 1% (i.e., 1.3%).

Additionally, to promote access to care for all Medicare beneficiaries, MedPAC is reiterating its March 2023 recommendation to establish safety-net add-on payments under the physician fee schedule for services delivered to low-income Medicare beneficiaries. The amount of the add-on payments would differ by specialty.

MedPAC estimates that the combined effect of these two recommendations would increase Fee Schedule revenue by an average of 5.7% for primary care clinicians and 2.5% for other clinicians.

Hospital inpatient and outpatient services (Chapter 3)
The Report states that in 2023, Medicare payment adequacy indicators for general acute care hospitals were mixed. While beneficiary access to care remained good, quality indicators were mixed, and Medicare payments remained below hospitals’ costs. The current law updates for hospital payment rates will not be finalized until this summer, but CMS’s current forecasts project an increase in base rates by over 2%. Therefore, MedPAC recommends that for 2026, the 2025 Medicare base payment rates for general acute care hospitals be updated by the amount reflected in current law plus 1%.

Medicare Advantage (Chapter 11)
Medicare Advantage (MA) enrollment continues to grow, with 54% of Medicare beneficiaries now enrolled in private MA plans. However, MedPAC raises concerns over higher payments to MA plans compared to fee for service (FFS) Medicare, largely driven by favorable selection and coding intensity. “Coding intensity” is defined as “the tendency for more diagnosis codes to be recorded for MA enrollees, which causes risk scores — and payments — for the same beneficiaries to be higher when they are enrolled in MA than they would be if they were in FFS Medicare.”

In 2025, Medicare is expected to pay MA plans about 20% more per enrollee than it would for the same beneficiaries in FFS Medicare, a difference totaling an estimated $84 billion. However, the Commission “remains committed to including private plans in the Medicare program.”

For 2026, MedPAC did not make any new recommendations for MA plans, but reiterated its past recommendations:

• Fully account for MA coding intensity
• Improve encounter-data accuracy and completeness
• Replace the quality-bonus programs with a new value-incentive program
• Establish more equitable benchmarks