Charles Baker, VP, Compliance Solutions

2025 Medicare Advantage Reforms

The Centers for Medicare & Medicaid Services (CMS) continues to build upon its strategy to support person-centered, value-based care through the 2025 Medicare Advantage and Part D programs proposed rule. These proposals, a bold stride towards enhancing health equity, transparency, and patient-centric care, promise to enhance the contours of the Medicare Advantage (MA) industry, impacting everything from behavioral health access to agent compensation.  

In this article about 2025 Medicare Advantage Reforms, we’ll explore:

  • Improving access to behavioral healthcare providers 
  • Mid-year enrollee notification of available supplemental benefits 
  • Enhancing guardrails for agent and broker compensation 
  • New standards for supplemental benefits for the chronically ill 
  • Annual health equity analysis of utilization management policies and procedures 
  • Enhancing enrollees’ rights to appeal a Medicare Advantage plan’s decision to terminate coverage for non-hospital provider services 
  • Increasing percentage of dual-eligible managed care enrollees who receive integrated Medicare and Medicaid services 
  • Limiting out-of-network cost-sharing for D-SNP PPOs
  • Standardizing Medicare Advantage plan risk adjustment data validation (RADV) appeals process 

Read About 2025 Medicare Advantage Reforms (PDF)

As the 2025 Medicare Advantage reforms usher in a new era of equity, transparency, and patient-centered care, ATTAC Consulting Group stands ready to guide your organization through these transformative changes. With our deep expertise in healthcare policy and strategy, we offer tailored solutions to help you navigate the complexities of behavioral health access, agent compensation, and integrated services for dually eligible individuals. Contact ATTAC to align your business with these significant reforms, enhance the quality of care for beneficiaries, and seize growth opportunities in a rapidly evolving Medicare Advantage landscape.