Staying informed about changes in Medicare is crucial, especially when it comes to managed care programs. For those involved with Medicare Advantage (MA) organizations, other health plans, or anyone interested in the operational side of Medicare health plan enrollment, several key updates have been released. These revisions, primarily for 2025, are designed to refine and clarify the enrollment and disenrollment processes within Medicare managed care. Let’s break down the significant changes you need to know.
One of the key updates is the revised guidance on enrollment and disenrollment instructions for Medicare Cost Plans. Announced by CMS on January 8, 2025, this update addresses the Special Election Period for individuals who are dually eligible for Medicare and Medicaid, as well as those who qualify for a Low-Income Subsidy (LIS). These revisions particularly impact cost plans that offer a Part D Optional Supplemental Benefit. Beyond these specific changes, the updated instructions also include:
- Alignment with the broader Medicare Advantage (MA) and Part D Enrollment and Disenrollment Guidance for consistent terminology and processes.
- Standardized language that refers to “individuals/enrollees” and expresses numbers as words, mirroring the MA and Part D guidelines for clarity.
- Updated model enrollment forms to ensure they are consistent in language with the MA and Part D model forms, simplifying the enrollment process for beneficiaries.
- Removal of outdated information, such as references to the Part D coverage gap phase (which ended in 2024) and obsolete contact information for the Social Security Administration, keeping the guidance current and relevant.
Further enhancing the clarity and usability of Medicare managed care program guidelines is the “Medicare Advantage and Part D Enrollment and Disenrollment Guidance” memorandum, updated for the Calendar Year 2025 and released on August 8, 2024. This comprehensive update streamlines the guidance for MA and Part D plans. Effective for requests received on or after January 1, 2025, these improvements include:
- Significant reduction in redundancy across chapters, cutting down the overall document length by approximately 130 pages, making the guidance more concise and user-friendly.
- Adoption of plain and consistent language throughout both MA and Part D program sections, ensuring clarity and easy understanding for all stakeholders.
- Increased use of visuals like graphics, tables, and text boxes to visually break down information and improve comprehension.
- Incorporation of content updates to reflect the latest regulatory changes effective in 2025, ensuring the guidance is up-to-date with current policies.
In addition to procedural guidance, there are also changes to the enrollment request forms. As of July 2, 2024, CMS announced additions to the model individual enrollment request form for Medicare Advantage Plans (MA) or Medicare Prescription Drug Plans (Part D). These additions, effective for enrollment requests from January 1, 2025, include new fields for:
- Sexual orientation and gender identity, aiming to gather more inclusive demographic data.
- Enrollee assistance information, to better understand and address the needs of enrollees requiring support.
- Option for submitting data in a compact disc (CD) format, providing flexibility in data submission methods.
These changes to the model enrollment forms impact all model forms within the enrollment guidance, ensuring a standardized approach across different aspects of Medicare managed care enrollment.
In Overview, these updates to Medicare enrollment and disenrollment processes are vital for anyone involved in Medicare managed care programs. Understanding these revisions ensures compliance, improves operational efficiency, and ultimately enhances the experience for individuals enrolling in Medicare health plans. Staying abreast of these changes is a key part of navigating the evolving landscape of Medicare managed care.
