The Centers for Medicare & Medicaid Services (CMS) announced updates on Thursday to Medicare Advantage and Part D plans for the contract year 2025.
The changes aim to enhance protections for enrollees, ensure fair competition among plans, and streamline benefits to meet the health care needs of Medicare beneficiaries more effectively.
Medicare Advantage, also known as Medicare Part C, offers an alternative way for Medicare beneficiaries to receive their Part A (hospital insurance) and Part B (medical insurance) coverage.
The plans are provided by Medicare-approved private companies that must adhere to rules set by Medicare. Often, Medicare Advantage plans include additional benefits not covered by Original Medicare, such as vision, dental, and hearing services, making them a comprehensive option for some beneficiaries.
One of the updates the CMS announced Thursday involves establishing new guardrails for plan compensation to agents and brokers, aimed at curtailing anti-competitive and anti-consumer steering practices.
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The CMS said it has finalized requirements setting a clear, fixed compensation amount for agents and brokers, addressing loopholes that have historically allowed for commissions that could influence the objectivity of plan selection.
Starting from the upcoming Annual Enrollment Period, the measures aim to ensure that compensation reflects only the legitimate activities required of agents and brokers.
The CMS has also set regulations to limit the distribution of personal beneficiary data by Third-Party Marketing Organizations (TPMOs). Those organizations will now be restricted from selling or reselling personal beneficiary data, the CMS said, a practice that has undermined rules against cold calling and resulted in intrusive marketing strategies for Medicare Advantage and Part D plans.
Addressing the need for accessible behavioral health services, the CMS is finalizing updates to network adequacy standards. This includes the establishment of a new facility-specialty provider category named “Outpatient Behavioral Health,” which covers a broad range of behavioral health providers.
The category seeks to guarantee that Medicare Advantage plan enrollees have access to behavioral health services, and the CMS noted it marks a step toward fulfilling the goals outlined in the CMS Behavioral Health Strategy.
Ensuring that enrollees are making the most out of their plans, the CMS said that Medicare Advantage plans will now be required to issue “Mid-Year Enrollee Notification of Unused Supplemental Benefits.” The initiative is designed to keep beneficiaries informed about the supplemental benefits available to them, many of which address social determinants of health needs, such as food insecurity or poor access to transportation.
Further, the CMS is setting new standards for supplemental benefits for the chronically ill, requiring Medicare Advantage plans to demonstrate, with research support, that the benefits have a reasonable expectation of improving the health or overall function of chronically ill enrollees.
The updates, according to the CMS, reflect its commitment to enhancing the Medicare program’s responsiveness to beneficiaries’ needs while promoting healthy competition among Medicare Advantage and Part D plans.
By introducing measures to protect enrollees from biased plan recommendations and ensuring greater access to behavioral health services, the CMS said it is aiming to foster a more equitable and effective Medicare landscape.
Newsweek has reached out to the Centers for Medicare & Medicaid Services by email for comment on Friday morning.
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