CMS finalized a slight decrease in Medicare Advantage (MA) benchmark payments for 2025. Along with decreasing payment rates for 2025, the CMS has revised how plans adjust for members’ risk and how quality or “star” ratings are calculated in the program. All have major ramifications on insurers’ ability to extract profits from MA.

Medicare will undergo some of the most significant changes in a generation. Changes to Medicare will include a $2,000 limit on out-of-pocket Part D drug costs, an opt-in payment plan, and some potential broad changes in Medicare Advantage plans.

Getting medical coverage denied with Medicare Advantage can be frustrating. Center for Medicare Director Meena Seshamani, M.D., examines why it could happen less.