7 Key Medicare Changes for 2025 You Need to Know

Posted by S.W.A.N. Insurance Agency
Estimated Reading Time 2 minutes 45 seconds

As we approach 2025, significant changes for Medicare are on the horizon, and they could impact your coverage and access to health care services. Understanding these updates is crucial for making informed decisions about your health care.

1. New Compensation Structures for Agents and Brokers

The Centers for Medicare & Medicaid Services (CMS) has introduced a new compensation model for agents and brokers to better prioritize the health care needs of enrollees. This new structure is designed to align compensation with the existing requirement that agents and brokers enroll individuals in plans that best meet their specific health care needs. The goal is to ensure that your health care choices are guided by what’s best for you, rather than by incentives that might influence your agent or broker.

2. New Protections Against Unwanted Marketing

Starting in 2025, there are stricter rules governing how third-party marketing organizations (TPMOs) can use your personal information. To protect you from invasive marketing tactics, TPMOs must now obtain explicit written consent before collecting or distributing your personal data for marketing purposes. This change is aimed at giving you more control over your personal information and reducing the risk of unwanted solicitations.

3. Strengthened Regulations on Marketing Practices

CMS is also tightening regulations on the marketing and communications of Special Supplemental Benefits for the Chronically Ill (SSBCI). These new rules are designed to prevent misleading marketing practices that could affect your enrollment decisions. By strengthening these regulations, CMS hopes to protect you from potentially deceptive marketing tactics and ensure that you have accurate information when choosing a plan.

4. Expanded Access to Behavioral Health Services

One of the most significant changes for 2025 is the expansion of access to behavioral health services. CMS is updating its network adequacy standards to include a broader range of behavioral health care providers. A new provider category has been added, reflecting CMS’s commitment to improving access to comprehensive care and supporting the mental well-being of Medicare beneficiaries. This expansion means that you will have greater access to mental health services, which are an essential part of overall health care.

5. Mid-Year Notification of Available Supplemental Coverage

Medicare Advantage plans will now be required to notify you mid-year of any unused supplemental coverage. This change is intended to ensure that you are fully aware of and able to utilize all available coverage under your plan. By receiving these notifications, you can make the most of the additional services provided through your Medicare Advantage plan.

6. More Rights to Appeal a Decision to Terminate Coverage for Non-Hospital Provider Services

If you’re enrolled in a Medicare Advantage plan, you now have expanded rights to appeal decisions regarding the termination of coverage for non-hospital provider services. This change gives you more opportunities to contest decisions that could affect your access to essential health care services, providing an additional layer of protection for your health care rights.

7. Updates to Medicare Part D Medication Therapy Management (MTM) Program

Lastly, there are important updates to the Medicare Part D Medication Therapy Management (MTM) program. The revisions ensure that more individuals have reliable access to MTM services. Notably, HIV/AIDS has been added to the list of core chronic diseases for MTM eligibility, potentially improving access to crucial medication management and related health care support. This change highlights CMS’s ongoing efforts to enhance the care provided to individuals with chronic conditions.

These changes to Medicare for 2025 reflect a strong commitment to improving the quality of care and protecting the rights of beneficiaries. Whether it’s expanding access to essential services or tightening regulations to prevent misleading practices, these updates are designed to enhance your Medicare experience.

If you have any questions about how these changes might affect your Medicare coverage, it’s important to seek advice from a licensed insurance broker.  Give us a call, and we can provide personalized guidance to ensure you’re making the best choices for your health care needs.