CMS proposes Medicare Advantage, Part D payment changes for CY 2025

Jan 31, 2024 - 04:38 PM
cms-nh-work-for-medicaid

The Centers for Medicare & Medicaid Services will accept comments through March 1 at 6 p.m. ET on its advance notice of proposed changes to Medicare Advantage plan capitation rates and Part C and Part D payment policies for calendar year 2025, which the agency estimates will increase MA plan revenues by an average 3.70%. This amounts to a $16 billion increase in overall payments, but represents a -0.16% reduction in the 2025 benchmark rate compared to current policy. The notice proposes updating the Part C risk adjustment model through a phased approach to reflect ICD-10 condition categories, 2018 fee-for-service diagnoses and 2019 FFS expenditures; and Part C and Part D Star Ratings to reflect the latest regulations. It also describes changes and additions to the standard Part D drug benefit under the Inflation Reduction Act of 2022. CMS expects to publish the final 2025 rate announcement by April 1.

Related News Articles

Headline
CMS releases form for submitting provider complaints on Medicare Advantage plans 
The Centers for Medicare & Medicaid Services has implemented an online form for providers to submit complaints regarding Medicare Advantage plans. A CMS…
Headline
AHA urges Elevance Health to rescind Anthem’s ‘Nonparticipating Provider Policy,’ citing harm to patient care access
The AHA Dec. 17 urged Elevance Health, which is the parent company of the Anthem brand of health plans, to rescind Anthem’s nonparticipating provider…
Headline
CMS announces pilot on MA service level data collection for initial determinations, appeals
The Centers for Medicare & Medicaid Services released a memo Dec. 16 announcing the agency’s intent to conduct a voluntary pilot in 2026, called the…
Headline
CMS proposes 2027 Medicare Advantage, Part D policies 
The Centers for Medicare & Medicaid Services Nov. 25 issued a proposed rule for policies governing the Medicare Advantage and Part D programs for 2027. CMS…
Headline
KFF analysis highlights limited physician access in Medicare Advantage plans
A new report from KFF reveals that Medicare Advantage enrollees had access to just 48% of the physicians available to Traditional Medicare beneficiaries in…
Headline
AHA shares concerns, recommendations with CMS on WISeR model
The AHA Oct. 23 recommended changes to the Centers for Medicare & Medicaid Services’ Wasteful and Inappropriate Services Reduction model to address…