#2025

The health plan industry has been in turmoil since an April 7, 2024 New York Times article appeared attacking prominent insurers and a data technology vendor, MultiPlan, for seemingly transferring huge out-of-network bills to commercial product patients.  Insurers are already battling major headwinds related to two other issues: So, is the MultiPlan issue yet another front on which health plans may have to fight? The public relations on the article alone has raised lawmakers’ eyebrows. The American Hospital Association has asked the federal Department of Labor to investigate both MultiPlan and large insurers to determine whether they engage in business practices that disadvantage patients and providers under the self-insured ERISA law and regulations. So what does MultiPlan do on behalf of health plans While the data and technology firm has networks and negotiation services, more and more MultiPlan is hired by insurers to scrutinize claims coming in from out-of-network providers

Just recently, the Centers for Medicare and Medicaid Services (CMS) finalized two important notices and rules impacting CY 2025: the 2025 annual rate-setting and policy notice as well as the draft 2025 Medicare Advantage and Part D rule. In this blog, I will write about both the 2025 final rule as well as the policy changes in the 2025 final notice. In my blog on April 4, 2024, I discussed the rate-setting components of the annual rate-setting and policy notice.  That blog is here: https://www.healthcarelabyrinth.com/final-2025-rates-for-medicare-advantage-remain-as-proposed/ . In addition, my February 1, 2024 blog on the draft notice is here and has more details: https://www.healthcarelabyrinth.com/2025-rates-for-medicare-advantage-plans-look-tight/ . They should be read together due to a few changes. In addition to the below, you can see my November 13, 2023 blog on the 2025 Medicare Advantage and Part D rule when it was first announced.  This has additional details but also should be