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

Jan 31, 2024 - 04:38 PM
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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.

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