7 Medicare Advantage and Part D Changes for 2025
As part of our commitment to keeping you informed about the latest developments in health care policy and how they may impact your coverage options, we want to highlight a few of the updates issued by the Centers for Medicare & Medicaid Services (CMS) for 2025.
If you or someone you love is a Medicare Advantage and Part D enrollee, these changes may enhance your protection and offer coverage that aligns more closely with your individual needs and preferences. For a complete list of updates, click here.
7 Key Medicare Changes for 2025
New Compensation Structures for Agents and Brokers: To prioritize the health care needs of enrollees, CMS has introduced a new compensation model for agents and brokers. This change is designed to better align compensation with the existing requirement that agents and brokers enroll individuals in the plans that best fit their health care needs.
New Protections Against Unwanted Marketing: The new rule sets clear limitations on how third-party marketing organizations (TPMOs) can use your personal data. To protect you from invasive marketing tactics, TPMOs will now require explicit written consent before they can collect or distribute your personal information for marketing purposes.
Strengthened Regulations on Marketing Practices: The rule includes new regulations for marketing and communications of Special Supplemental Benefits for the Chronically Ill (SSBCI) to prevent misleading marketing practices that may impact enrollment decisions.
Expanded Access to Behavioral Health Services: CMS is updating its network adequacy standards to ensure broader access to behavioral health care providers. A new provider category has been added, emphasizing CMS's focus on improving access to comprehensive care and supporting the mental well-being of Medicare beneficiaries.
Mid-Year Notification of Available Supplemental Benefits: Medicare Advantage plans must notify you mid-year of unused supplemental benefits such as vision, hearing, fitness, and dental to ensure awareness and utilization of available benefits.
More Rights to Appeal a Decision to Terminate Coverage for Non-Hospital Provider Services: If you have a Medicare Advantage plan, you now have additional rights to appeal decisions to terminate coverage for non-hospital provider services.
Updates to Medicare Part D Medication Therapy Management (MTM) Program: The revisions ensure that individuals have reliable and increased access to MTM services. As part of these changes, HIV/AIDS has been included in the list of core chronic diseases for eligibility, potentially improving patient access to medication management and related health care support.
Navigating the world of Medicare can be difficult, but don’t worry, our team is here to help you understand your plan and ensure your coverage continues to meet your needs. If you have any questions about these updates or your current coverage, please don't hesitate to get in touch.