CHA News

Summary: Finalized Policy Changes for MA Plans in Contract Year 2025

What’s happening: A summary of the finalized changes to Medicare Advantage (MA) and Part D programs for contract year 2025 is now available.  

What else to know: The regulation is effective June 3.  

The members-only summary, from Health Policy Alternatives, Inc., details the finalized changes, including: 

  • Streamlining the appeals process for enrollees if their MA plan terminates coverage for certain post-acute care services 
  • Standardizing the appeals process for MA risk adjustment data validation audit findings 
  • Limiting out-of-network patient cost-sharing for certain plans serving dually eligible enrollees 
  • Giving Part D plans more flexibility to substitute biosimilars for reference drug products 

Additional details are available in a Centers for Medicare & Medicaid Services fact sheet