what changes are coming to medicare advantage plans in 2025

3 min read 23-11-2024

what changes are coming to medicare advantage plans in 2025

Medicare Advantage (MA) plans, also known as Part C, offer an alternative to Original Medicare (Parts A and B). These plans provide comprehensive coverage, often including prescription drug coverage (Part D), vision, hearing, and dental benefits. However, these plans are constantly evolving, and 2025 brings several notable changes. This article will explore the key updates you need to know.

Key Changes to Medicare Advantage in 2025

While the specifics are still being finalized by the Centers for Medicare & Medicaid Services (CMS), several significant changes are anticipated for 2025 Medicare Advantage plans:

1. Potential Changes to Drug Pricing and Coverage

One of the most significant areas of potential change revolves around prescription drug pricing and coverage. CMS is continually evaluating strategies to lower drug costs for beneficiaries. This might involve:

Negotiated Drug Prices: The Inflation Reduction Act (IRA) has already begun impacting drug prices, and its effects will continue to ripple through MA plans in 2025. Expect some adjustments in formulary design and cost-sharing based on these negotiations.
Increased Transparency: CMS is pushing for increased transparency in drug pricing and how MA plans utilize their formularies. This means beneficiaries may have more readily available information about drug costs and coverage decisions.
Changes to Part D Plans: Because many Medicare Advantage plans include Part D coverage, changes to Part D will directly affect MA plans. Stay informed about any modifications to the Part D benefit.

2. Expanding Access to Mental Health and Substance Use Disorder Services

The increasing recognition of mental health and substance use disorder (SUD) needs has prompted efforts to improve access to these services within MA plans. Expect to see:

Enhanced Coverage: Many MA plans are expanding their coverage of mental health and SUD services, including therapy, medication management, and addiction treatment programs. Look for plans that prioritize these essential benefits.
Improved Access: CMS is focusing on removing barriers to accessing these vital services, such as network adequacy and provider availability.
Telehealth Expansion: Telehealth is likely to continue expanding as a convenient and accessible option for accessing mental health and SUD care.

3. Continued Focus on Preventative Care

Preventive care remains a crucial component of Medicare Advantage plans. In 2025, we can anticipate:

Emphasis on Chronic Disease Management: MA plans will continue to prioritize programs designed to manage chronic conditions such as diabetes, heart disease, and hypertension.
Expanded Wellness Programs: Expect increased investment in wellness and preventative programs, promoting healthy lifestyles and early detection of health issues.
Incentives for Participation: MA plans may offer incentives to encourage beneficiaries to participate in preventative care programs.

4. Possible Changes to Plan Star Ratings

The CMS Star Ratings system plays a crucial role in evaluating the quality of Medicare Advantage plans. While specific changes aren't confirmed, potential alterations could include:

New or Revised Quality Measures: CMS might introduce new quality measures or revise existing ones to better reflect the evolving healthcare landscape.
Increased Weighting of Certain Measures: The weight given to specific quality measures may change, emphasizing certain aspects of care.
Impact on Plan Enrollment: Changes in Star Ratings can significantly influence beneficiary enrollment patterns, as individuals may opt for higher-rated plans.

5. Increased Regulatory Scrutiny

The government continues to increase its oversight of Medicare Advantage plans. Expect to see:

Greater Transparency Requirements: MA plans will be subject to more stringent reporting requirements, aimed at ensuring accuracy and transparency in their operations.
Increased Audits and Reviews: CMS is expected to conduct more frequent audits and reviews of MA plans to verify compliance with regulations and ensure beneficiaries are receiving quality care.

How to Prepare for 2025 Medicare Advantage Plan Changes

Staying informed about these potential changes is crucial to making informed decisions about your Medicare coverage. Here are some steps to take:

Monitor CMS Updates: Regularly check the CMS website for official announcements and updates regarding Medicare Advantage plans.
Compare Plans: Use Medicare.gov's Plan Finder tool to compare available plans in your area and identify those that best meet your individual needs.
Contact Your Current Plan: Reach out to your current MA plan to inquire about any anticipated changes for 2025.
Consult with a Healthcare Professional: Talk to your doctor or other healthcare professionals to get personalized advice based on your health status and needs.

Disclaimer: This article provides general information and is not intended as medical or financial advice. Always consult with qualified professionals for personalized guidance. The information presented here is based on current expectations and may be subject to change. Always refer to official CMS resources for the most up-to-date information.