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CY 2023 Medicare Advantage and Part D Proposed Rule (CMS-4192-P)-2026
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What changes are coming to Medicare Part D in 2023?
Starting in 2023, people with Medicare Part D coverage pay no more than $35/month per covered insulin product. This benefit will expand to Part B coverage on July 1, 2023.
Is the Medicare Part D donut hole going away in 2025?
The Part D defined standard benefit is changing for 2025 and will include a new $2,000 cap on out-of-pocket drug spending. The benefit will have three phases, including a deductible, an initial coverage phase, and catastrophic coverage.
What is the final rule for Medicare Advantage 2025?
Starting in January 2025, Medicare Advantage plans will not be allowed to change eligibility criteria in the middle of a plan year. Medicare Advantage plans will be required to use objective criteria when determining whether an enrollee is eligible for SSBCI.
What is the CMS proposed rule for Medicare Advantage 2023?
The proposed rule builds on CMS work to remove unnecessary barriers to care resulting from the inappropriate use of prior authorization and internal coverage criteria. The rule would also increase guardrails on the use of artificial intelligence (AI) to protect access to health services.
What is the Part D benefit design for 2025?
In 2024, the Part D benefit consists of four phases annual deductible, initial coverage, coverage gap, and catastrophic coverage. CMS will eliminate the coverage gap phase in 2025, further ensuring the end of the donut hole era.
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What is the contract year CY 2025 Medicare Advantage and Part D final rule?
The Contract Year (CY) 2025 Medicare Advantage and Part D final rule builds on existing CMS policies to promote competition, increase access to care, including important behavioral health services, and protect individuals from inappropriate marketing and prior authorization.
Related links
Jan 12, 2022 This proposed rule would revise the Medicare Advantage (MA) (Part C) program and Medicare Prescription Drug Benefit (Part D) program regulations.Read more
The proposed rule would improve beneficiaries experiences with MA and Part D, with a strong emphasis on individuals who are dually eligible for Medicare and