The Centers for Medicare & Medicaid Services (CMS) recently announced updates for Medicare Advantage and Part D plans for the contract year 2025. These changes are designed to enhance protections for enrollees, promote fair competition among plans, and streamline benefits to better meet the healthcare needs of Medicare beneficiaries. Medicare Advantage, also known as Medicare Part C, provides an alternative way for beneficiaries to receive their Part A and Part B coverage through private companies approved by Medicare.
One of the updates involves establishing new guardrails for plan compensation to agents and brokers to address anti-competitive and anti-consumer steering practices. The CMS has finalized requirements that set a clear, fixed compensation amount to ensure that commissions do not influence plan selection. Additionally, regulations have been set to limit the distribution of personal beneficiary data by Third-Party Marketing Organizations (TPMOs), aiming to prevent intrusive marketing strategies for Medicare Advantage and Part D plans.
The CMS has also finalized updates to network adequacy standards to address the need for accessible behavioral health services. This includes the creation of a new provider category called “Outpatient Behavioral Health,” aimed at ensuring Medicare Advantage plan enrollees have access to a wide range of behavioral health providers. These updates align with the CMS Behavioral Health Strategy and aim to improve access to vital mental health services for beneficiaries.
To help enrollees make the most of their plans, Medicare Advantage plans will now be required to issue “Mid-Year Enrollee Notification of Unused Supplemental Benefits.” This initiative aims to keep beneficiaries informed about the supplemental benefits available to them, especially those addressing social determinants of health needs such as food insecurity or transportation issues. The CMS is also setting new standards for supplemental benefits for the chronically ill, requiring plans to demonstrate that these benefits have a reasonable expectation of improving the health or overall function of enrollees.
Overall, these updates reflect the CMS’s commitment to enhancing the responsiveness of the Medicare program to meet beneficiaries’ needs while promoting healthy competition among Medicare Advantage and Part D plans. By introducing measures to protect enrollees from biased recommendations and increasing access to behavioral health services, the CMS seeks to create a more equitable and effective Medicare landscape for beneficiaries. Newsweek reached out to the CMS for comment on these updates.
