CMS is giving Elevance more time to respond to the CMS enforcement notice regarding its questions about Elevance’s risk adjustment data submitted from November 2018 to October 2025. Elevance now has until May 30, 2026 to respond to CMS about this memo and the risk-adjustment data CMS questions.
CMS is also announcing that several existing Elevance employer groups’ retiree health plans, as well as certain other health plans, are exempt from any future sanctions. These health plans include contracts H0629, H1212, H2441, H2687, H4003, H4004, H4694, H4704, H6988, H7220, and H7522.
Elevance and CMS are working to address the questions CMS has about the risk-adjustment data Elevance submitted during the dates we previously mentioned. This extension shows there’s progress in the talks, along with the exemption of these health plans from any potential sanctions.
Agility will provide more updates on discussions between CMS and Elevance as soon as we have them, so Medicare agents can plan and act accordingly.
The Agility Difference
As the insurance market continues to evolve, Agility helps you deliver the best client experience with our team’s decades of expertise, setting you up for growth. With Agility, you also get Dedicated Producer Support at (866) 590-9771 or support@enrollinsurance.com to answer your insurance questions and connect you with our Medicare, ACA, and ancillary experts.
They can also add you to our weekly email list for tips and updates. Let Agility help you grow your skills and take advantage of client experience opportunities in 2026.
CMS is sanctioning Elevance Medicare Advantage plans by suspending new enrollment and marketing for the plans on March 31, 2026. Elevance has until this date to submit all data corrections and an attestation for its risk adjustment data submissions made from November, 2018 through October, 2025.
CMS is also alleging that Elevance annually certified the data without knowing the unverified codes being used weren’t corrected using the systems CMS requires MA plans to use. This is not a final CMS ruling, and Elevance has time to respond by providing the information CMS wants by this date.
Agility will provide updates on this breaking news as we receive it.
The Agility Difference
With the ongoing evolution of the insurance market, Agility empowers you to develop a comfortable, successful retention strategy through our team’s expertise, positioning you for maximum growth. With Agility, you get Dedicated Producer Support at (866) 590-9771 or support@enrollinsurance.com to answer any insurance questions and direct you to our Medicare, ACA, and ancillary experts.
They can also add you to our weekly email list for tips and updates. Let Agility empower you to evolve your capabilities and capture the opportunities in 2026.
