There are significant changes impacting Medicare in 2025. New rules introduced by the Centers for Medicare & Medicaid Services (CMS) seek to improve communication with members while increasing utilization of benefits. This means, it is more important than ever for Medicare Advantage (MA) plans to take stock of how supplemental benefits are tracked and administered. To assist your team in translating the volume of new information, here are some of the biggest regulatory changes coming, along with guidance to ensure your plan will be compliant while also contributing to your competitive advantage.
What’s new in 2025: Key supplemental benefit updates
Here’s a breakdown of the major changes you need to be aware of, including important deadlines:
- Mid-year notice of unused supplemental benefits, due January 2026
Starting January 1, 2026, MA organizations will be required to send a mid-year notice to members, highlighting any unused supplemental benefits after June 30, but no later than July 31st of the plan year. It’s intended to remind members about the valuable services they may not be taking advantage of—such as dental, vision and transportation benefits. Ensuring that members make full use of these benefits could have a significant impact on their health, satisfaction with their plan and their overall quality of life. - SSBCI documentation requirements, effective 2025 bid process
Managing Special Supplemental Benefits for the Chronically Ill (SSBCI) received an increase in formality. Beginning in calendar year 2025, plans will be required to document approvals and denials for SSBCI eligibility. In addition, CMS will be reviewing the supporting evidence for these benefits on a yearly basis to ensure compliance. While the additional layer of accountability may result in an increase in workload, it ultimately ensures a superior level of care for chronically ill members. - Member outreach and engagement
As discussed above, one of CMS’ largest priorities is ensuring members fully use the benefits they’re entitled to. To remain competitive, plans will need to increase their outreach efforts to inform members about benefits they have yet to access. It is important to emphasize that this is not just a box ticking exercise; this effort is about ensuring members are fully aware of how unlocking the full scope of MA services can make a significant impact in their day-to-day activities. - Optimizing rebates for supplemental benefits
CMS intends to ensure that MA plans are using rebates to expand and enhance access to supplemental benefits. For plans, this means tracking how benefits are used throughout the year and making timely adjustments to ensure members are getting the utmost from their coverage.
The challenges health plans face with supplemental benefits
While these new regulations are intended to improve member experiences, they may bring some operational challenges. Here’s what you need to watch out for:
- Increased administrative load
Managing the increased amount of required SSBCI documentation may be a heavy lift. Plans will need to ensure that systems are in place to handle the additional paperwork to avoid bogging down operations. Plans must not be simply compliant—they must remain efficient. - Driving member engagement
With the new mid-year notices and outreach requirements, it’s more important than ever to ensure members fully understand exactly which benefits are available to them. Here’s the rub: if members aren’t engaged, they’re unlikely to utilize their benefits. That’s bad for them and could also damage your plan’s performance. - Balancing cost and utilization
Now for the elephant in the room. Increased benefit utilization could mean higher costs for health plans. It’s a delicate balance—ensuring members fully access the benefits they are entitled to while also managing the potential hike in expenses. However, by ensuring industry best practices are in place, these costs can be mitigated by focusing on preventative care and early interventions that ultimately reduce long-term healthcare expenses. Encouraging the use of benefits like preventative screenings, transportation to medical appointments, and chronic illness management strategies can meaningfully lower emergency care costs while improving member health in the long run. - Data overload
With more data than ever to track and report, MA plans require integrated data systems capable of shouldering the load. From tracking benefit utilization to keeping tabs on rebates and member engagement, a system that delivers real-time insights is a must-have to assist you in staying on top of everything.
How we can help you stay ahead
At Healthmine, we understand these changes may feel like a lot to manage. Our Saas platform is designed to help health plans adapt during seasons of change. And in consultation with our MA experts, we can deliver a tailored engagement strategy that meets current and anticipated regulatory challenges. We specialize in supporting health plans to achieve and maintain CMS regulation compliance while simultaneously optimizing their operations, ensuring plans get the most out of these changes.
- Compliance without the hassle. We’ll help you streamline your SSBCI documentation and reporting processes, so you’re never caught unawares by new requirements.
- Member engagement that works. Our team can craft tailored outreach strategies to ensure your members know exactly what benefits they have and how to use them. Our focus is on building engagement that drives real results—like higher benefit utilization, improved member satisfaction, and more. We will guide plans through engagement efforts housed in our Quality Relationship Management(TM) (QRM(R) platform, bringing teams from across the organization together into a single tool to assess engagement effectiveness and coordinate efforts.
- Data, simplified. Don’t let the new data requirements overwhelm you. We’ll help you set up or optimize your data systems so you can easily track everything from benefit utilization to rebate optimization, giving you a crystal clear picture of your plan’s performance. We know how disruptive, and expensive, siloed data systems can be.
- Cost management strategies. While higher benefit utilization may drive up short-term costs, we assist health plans in the implementation of cost-saving strategies focused on preventative care and early interventions. These strategies can reduce the long-term burden of higher-cost care, such as hospitalizations and emergency services, ensuring that your plan remains in robust financial health. Our team can identify the right balance between short-term and long-term solutions that optimize budgets while setting teams up for success in Star Ratings.
Are you ready for 2025?
The 2025 Medicare changes are just around the corner; the way you handle these new regulations could have a significant impact on your plan’s success. From new mid-year notices to enhanced SSBCI documentation, there certainly is much to consider. The good news is, with the correct approach, these updates can be an opportunity to improve how you deliver supplemental benefits and engage with your members.
We are here to guide you every step of the way as you navigate these changes. Let’s work together to ensure your plan is compliant, efficient, profitable, and—most importantly—delivers exceptional service to your members. Reach out to us today to learn more.