Medicare Advantage plans must comply with new network adequacy and health equity standards in 2025.
Here are five policy changes taking effect in 2025:
- CMS will require Medicare Advantage plans to meet new standards for behavioral health network adequacy in 2025. Plans will be required to meet standards for access to outpatient behavioral health providers, including marriage and family therapists, mental health counselors and opioid treatment providers.
- Beginning in 2025, Medicare Advantage plans must include a health equity expert on panels reviewing prior authorization requirements. In addition, MA insurers will have to evaluate the effect their prior authorization policies have on health equity.
- Plans will be required to send enrollees a mid-year notice to enrollees, listing any supplemental benefits they have access to in their plan that they have not used.
- CMS will also implement stricter guidelines on supplemental benefits for chronically ill enrollees. Plans will be required to prove any supplemental benefits for these enrollees have a reasonable expectation of improving or maintaining their health.
- Several major changes to Part D benefits will take effect in 2025, including a $2,000 cap on out-of-pocket prescription drug costs. Enrollees will also be able to choose to spread out high drug costs over the entire year.
CMS also proposed capping the amount that agents and brokers can be compensated by MA plans, regardless of the plan a beneficiary enrolls in. In July, a federal judge paused implementation of the regulation in response to a lawsuit from insurance brokers.
Read more about CMS' 2025 final rule for MA plans here.