20. 2025 Medicare Advantage Rates and Policy Changes Finalized

There are a lot of major changes in store for Medicare Advantage plans in 2025, from another very tight rate announcement and a myriad of policy changes.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through the Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode of the Healthcare Labyrinth Podcast, Marc discuss the major finance and policy changes just finalized by the Centers for Medicare and Medicaid Services for 2025. Medicare Advantage (MA) plans are in for another tight rate year despite rising medical expense. And there were a myriad of policy changes adopted by CMS for 2025 as well.

Key Takeaways:  

CMS finalized 2025 rates and like 2024 the rate is very tight despite major utilization and medical expense increases that are occurring.

The deficient rate hike is tied to the phase-in of a new risk adjustment model that seeks to curb overcoding.

The rate will lead to diminishing benefits in the MA program. Low-income enrollees who rely on such benefits will be hurt.

A number of changes are being made for the 2025 and 2026 Star years. CMS also has a very active road map of proposed changes in future years.

There are major policy changes announced for 2025, including curbs on the power of marketing agencies and brokers, enhancing behavioral health networks, and ensuring supplemental benefits are better utilized.

New external appeals rights are given to MA enrollees and major dual eligible Special Needs Plan integration is planned.

Biosimilar uptake and promotion is encouraged with some changes as well.

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