CMS CY2025 MA & Part D Final Rule

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Background

On April 4, 2024, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that revises the Medicare Advantage Program, Medicare Prescription Drug Benefit Program (Medicare Part D), Medicare Cost Plan Program, Programs of All-Inclusive Care for the Elderly (PACE), and Health Information Technology Standards and Implementation Specifications. Additionally, this final rule addresses several key provisions that remain from the CY 2024 Medicare Advantage and Part D proposed rule, CMS-4201-P, published on December 14, 2022. Together, the changes in this final rule build on existing Biden-Harris Administration policies to strengthen protections and guardrails, promote healthy competition, and ensure Medicare Advantage and Part D plans best meet the needs of enrollees. In addition, these policies promote access to behavioral health care providers, promote equity in coverage, and improve supplemental benefits.

This fact sheet discusses the major provisions of the 2025 final rule which can be downloaded here: https://www.federalregister.gov/public-inspection/2024-07105/medicare-program-medicare-advantage-and-the-medicare-prescription-drug-benefit-program-for-contract

 

CMS Newsroom Medicare Part D

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Final CY 2025 Part D Redesign Program Instructions Fact Sheet

| Medicare Part DToday, the Centers for Medicare & Medicaid Services (CMS) released the Final Calendar Year (CY) 2025 Part D Redesign Program Instructions (the Final Program Instructions) concurrently with the CY 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate Announcement). The purpose of the Final Program Instructions is to provide interested parties with guidance for CY 2025 regarding, among other topics, the implementation of section 11201 of the Inflation Reduction Act of 2022 (IRA) (P.L. 117-169), signed into law on August 16, 2022, which made several amendments and additions to the Social Security Act (“the Act”) that affect the structure of the defined standard Part D drug benefit.

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Cigna Confirms Cleveland Clinic to Remain In Network

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Great news! Cleveland Clinic will remain in our MA network in Florida and Ohio.

After productive negotiations with Cleveland Clinic, we are happy to announce that they will remain in our Medicare Advantage (MA) network in Florida and Ohio! This includes all Primary Care Physicians (PCPs), specialists, ancillary providers, and hospitals.

 

With the contractual agreement reached, there will be no disruption in access to services with Cleveland Clinic. Customers can continue to use their Cleveland Clinic providers.

 

In the coming weeks, customers will receive letters informing them that Cleveland Clinic remains in network and that no action is needed at this time. All Cleveland Clinic PCP assignments remain unchanged.

 

If you have any questions, please reach out to your local Broker Managers. As a reminder, you can always search our online provider directory to view the most up-to-date provider listing in your market.

 

Thank you for your partnership!

After productive negotiations with Cleveland Clinic, we are happy to announce that they will remain in our Medicare Advantage (MA) network in Florida and Ohio! This includes all Primary Care Physicians (PCPs), specialists, ancillary providers, and hospitals.

CSM’s Employee Spotlight Featuring: Tania Wade

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Congratulations Tania Wade for her second year of service with Cornerstone Senior Marketing!

Tania plays a vital role on our Service Team, bringing over 30 years of exceptional customer service experience. She excels in providing informative education and value-added research to our agents. Tania is dedicated to finding solutions and addressing any questions or issues that arise. Additionally, she has embarked on her journey towards obtaining her ACS (Associates in Customer Service) degree this year and has recently completed certification in ‘CX 50 (Customer Experience) – Impact Cx: The Quest’ via LOMA.

Cornerstone Senior Marketing appreciates Tania for her outstanding service to our agents!

Interesting Read: Chartis: A look at Medicare Advantage enrollment trends in 2024

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Medicare Advantage (MA) growth has broadly slowed, but the biggest players in this space continue to claim the lion’s share of this expansion, according to a new report from healthcare consultant Chartis.

The analysis found that 1.7 million lives were added to the MA rolls for the 2024 plan year, and, of those, 1.4 million, or 86%, were captured by the three largest insurers in this segment: UnitedHealthcare, Humana and Aetna. Aetna, in particular, had a strong showing during the annual enrollment period, adding 476,000 enrollees, or 60% of those who signed up during that window.

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CONSUMER ALERT REMINDER: Ohioans Cautioned to Watch for Medicare Medical Supplies Scam

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For Immediate Release
March 7, 2024
Media Contact
Todd Walker
todd.walker@insurance.ohio.gov

 

COLUMBUS — Ohio Department of Insurance Director Judith L. French warns Ohioans on Medicare to watch for fraudulent Medicare claims made with their Medicare numbers for medical supplies, most notably urinary catheters, back and knee braces, and glucose monitors.
The scammers are using individuals’ Medicare numbers and fraudulently billing Medicare, oftentimes thousands of dollars per fraudulent claim. Affected individuals are not impacted financially but face a confusing and stressful situation, including obtaining a new number and card from Medicare and possible complications in receiving legitimate medical supplies in the future.

Red flags to watch for:

• You do not recognize the ordering physician’s name nor have you been seen by the physician.
• The ordering physician is located in another state.
• You receive an Explanation of Benefits document or Medicare Summary Notice document with a large quantity of supplies you have never received.
• You do not have a medical condition that would require the supplies.

Ohioans who have been affected by this Medicare scam should contact the Ohio Senior Medicare Patrol at 800-293-4767 or go to proseniors.org to report the scam and get help obtaining a new Medicare number and card.

Ohioans with Medicare questions can contact the Ohio Department of Insurance’s Ohio Senior Health Insurance Information Program (OSHIIP) at 800-686-1578, oshiipmail@insurance.ohio.gov, and insurance.ohio.gov. OSHIIP is the state’s official Medicare educational and counseling program.
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Deft Research: Which MA supplemental benefits do Duals want most?

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Take a Look into Duals’ Supplement Preferences

At Deft Research, we’re dedicated to uncovering Medicare insights that help carriers, agencies and marketers serve clients better. And every month, we share select insights on our blog.

 

This month, we’re exploring some of our most profound learnings about Duals and their interest in MA supplemental benefits. In our 2024 National Dual Eligible Benefit Design Study, we took a closer look at the importance of Dual’s unique needs, as well as Duals’ preferences for supplemental benefits. Our takeaway? 

 Of the eight supplemental benefits we tested, dental benefits emerged as the most important for Duals and low-income non-Duals (LINDs). 

READ THE BLOG

 

Get our Free Snapshot on Duals

Based on our 2024 National Dual Eligible Benefit Design Study, this one-page infographic offers a birds-eye view into Medicare Advantage plan design preferences among Dual eligibles and low-income non-Dual seniors.

It’s perfect for a quick overview. Plus, some of our findings may cause you to rethink your plan designs.

 

DOWNLOAD THE FREE DUALS SNAPSHOT

ADS & Devoted Health Ohio Teaming Up to Help Diabetic Clients

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ADS is excited to share that Advanced Diabetes Supply has now signed a limited contract with Devoted Health in Ohio!!Agents, you can begin referring your Ohio Devoted members who need a meter and test strips to ADS starting NOW!www.northcoastmed.com/laura-clinansmithWhile ADS is now able to provide a meter, test strips and other ancillary supplies like needles and syringes, they are NOT able to serve those members who are using a CGM (Dexcom or Libre) at this time.

ADS is excited to extend their services to your members with Devoted in Ohio.

 

If you have any questions, please reach out to your CSM Rep! 614-763-2255

KFF – New $2,000 Medicare Part D Cap Begins in 2025

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New $2,000 Medicare Part D Cap could reduce out-of-pocket drug costs for over one million beneficiaries beginning next year, including tens of thousands of beneficiaries in most states.  Millions more will reach the spending threshold and benefit from the cap over time

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Anthem Insurance Carrier Face Becoming Out-Of-Network with Reid

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Posted February 5, 2024 at 6:11am by Jeff Lane

Ref: https://kicks96.com/local-news/727456

(Richmond, IN)–Tens of thousands of area residents who have Anthem health insurance are set to be impacted if Reid Health becomes out-of-network for Anthem.  Kicks 96 and 101.7 The Point News was informed last week by a source close to the situation that patients of Reid Health and its providers would soon receive a letter stating that Reid has been unsuccessful in reaching an agreement with Anthem and will terminate the relationship with Anthem to stand up for its healthcare providers.  The letter has now been sent and states that Reid will be out-of-network for Anthem beginning March 18 unless an agreement is reached.  More than 44,000 area patients stand to be impacted.  A website has been created to give more information.  It’s reidhealthaccess.org.