CMS continues to press MA plans 

WASHINGTON – CMS has finalized policies that it says will continue to strengthen protections and guardrails to ensure Medicare Advantage and Medicare Part D prescription drug plans best meet the needs of enrollees. 

The Contract Year 2025 Medicare Advantage and Part D final rule will: 

• Establish a set amount a plan can compensate an agent or broker to protect Medicare Advantage and Part D plan enrollees and prospective enrollees from anti-competitive steering. 

• Require that Medicare Advantage plans include an expert in health equity on their utilization management committees and conduct an annual health equity analysis of their prior authorization policies and procedures. 

• Finalize new guardrails for certain types of supplemental benefits, available only to chronically ill enrollees, to ensure they meet the health needs of enrollees and are supported by evidence and require plans to send a mid-year, personalized communication to their enrollees about accessing unused supplemental benefits. 

“CMS is continuing its commitment to ensuring that Medicare Advantage and Part D prescription drug plans remain strong, stable, and affordable for people with Medicare,” said CMS Administrator Chiquita Brooks-LaSure. “This final rule builds on Biden-Harris Administration efforts to strengthen consumer protections so that people with Medicare can more easily choose the Medicare coverage options that are right for them.” 

View a fact sheet on the final rule here. 

• CMS also recently released the Calendar Year 2025 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies, which outlined a 3.7% increase in payments to Medicare Advantage plans – worth more than $16 billion – from 2024 to 2025. 
• Additionally, CMS reminds the public to consider submitting comments to the Medicare Advantage Data Request for Information (RFI) announced in January. Comments are due on May 29, 2024.