National General Medicare Supplement 2025 – Plans & Rates

Navigating the national general Medicare supplement 2025 changes can be challenging. This article cuts through the complexity, giving you a concise overview of the premium adjustments, benefits, and regulatory shifts you should anticipate. By the end, you’ll be well-informed about your National General Medicare Supplement options, helping you decide with confidence.

Key Takeaways

• CMS’s 2025 rule updates propose enhanced beneficiary protections, better access to behavioral health care, and improvements to Medicare Advantage plan supplemental benefits, including a requirement for plans to notify enrollees mid-year about unused supplemental benefits.
• National General will adapt to 2025 CMS updates by adjusting to network adequacy standards, standardized broker compensation and increased Medicare Part D risk adjustment model changes to align with industry standards and CMS’s focus on health equity.
• Beneficiaries must navigate enrollment and eligibility with care, understanding the key differences between Medicare Supplement and Medicare Advantage plans and the consequences of switching plans outside of designated open enrollment periods.

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National General is at the forefront of providing Medicare Supplement plans, offering Medicare beneficiaries additional coverage options to manage out-of-pocket costs and enhance their healthcare experience. The year 2025 brings a series of proposed changes by the Centers for Medicare & Medicaid Services (CMS), aiming to strengthen beneficiary protections, promote access to behavioral healthcare providers, and improve supplemental benefits for Medicare Advantage plans.

The CMS proposed rule for 2025 includes new guardrails for plan compensation to agents and brokers to prevent anti-competitive steering of beneficiaries and standardizing commissions. It is also proposing to enhance network adequacy standards for Medicare Advantage plans by including a range of behavioral health providers, such as marriage and family therapists, mental health counselors, and opioid treatment program providers, under one category called “Outpatient Behavioral Health”, which is a part of behavioral health care services, including behavioral health counseling and community mental health centers. This enhancement aims to bridge the gap between traditional Medicare and Medicare Advantage plans in terms of access to comprehensive care.

As part of its initiatives to improve healthcare accessibility, CMS proposes more flexibility for Part D sponsors to substitute lower-cost biosimilar biological products for their reference products without prior CMS approval. This move aims to allow enrollees to access more affordable options sooner, ultimately helping to lower prescription drug costs.

One significant change proposed for 2025 is the requirement for Medicare Advantage plans to issue a “Mid-Year Enrollee Notification of Unused Supplemental Benefits”. This initiative aims to inform enrollees about any supplemental benefits not accessed in the first six months of the year, ensuring beneficiaries make the most of the available supplemental benefits.

Lastly, CMS has set forth new requirements for Medicare Advantage plans to prove that special supplemental benefits for the chronically ill (SSBCI) are expected to improve health or overall function and are supported by research. These changes underline CMS’s commitment to bolstering the Medicare Advantage Program and improving the overall experience for Medicare Advantage enrollees.

Aligning with CMS Updates: How National General Adapts to Changes

Adapting to CMS updates is crucial for healthcare providers to stay compliant with industry standards and provide the best care to beneficiaries. National General is no exception and is geared up to align with the CMS updates for 2025. This includes changes to:

• Risk adjustment models
• Network adequacy standards
• Broker compensation
• Health equity initiatives

For instance, in 2025, the National General will adapt to the CMS update that predicts an average increase of 3.70 percent in Medicare Advantage payments. This update effectively manages over a $16 billion increase from the previous year. Furthermore, the company will continue with the three-year phase-in of the updated Part C Risk Adjustment model, balancing 67% of the risk score with the new 2024 model and 33% with the 2020 model, as proposed by CMS for CY 2025.

Updates to network adequacy standards, including the addition of behavioral health providers as a recognized facility specialty, will be reflected in how National General structures its network according to the latest CMS guidelines. Additionally, new CMS guardrails for brokers’ and agents’ compensation are in place, and the National General will adhere by setting a fixed payment amount, promoting fairer Steering Practices.

National General is also committed to CMS’s push for health equity, updating utilization management policies, including Utilization Management committee responsibilities, and conducting and publicly sharing an annual health equity analysis of prior authorization policies. The company also intends to enhance access to integrated Medicare and Medicaid services for a higher percentage of dually eligible Medicare Advantage Plan enrollees, in keeping with CMS’s proposed rule.

In line with CMS initiatives, National General will revise their strategies to accommodate the updates to the Medicare Part D risk adjustment model reflecting changes under the Inflation Reduction Act, including increased plan liability due to the new $2,000 cap on annual beneficiary out-of-pocket spending. With these changes, National General continues to align with CMS updates, ensuring compliance and alignment with industry standards.

Navigating Enrollment and Eligibility for 2025

Understanding the enrollment and eligibility process for 2025 Medicare Supplement plans is essential for beneficiaries. Eligibility for enrolling in Medicare Supplement insurance, offered by National General, requires the individual to have Medicare Part B. However, it is important to note that switching from Medicare Advantage to a Medicare Supplement plan outside of the 6-month Medigap Open Enrollment Period may result in higher premiums or denial of coverage.

This means that timing is crucial when considering a switch from Medicare Advantage to a Medicare Supplement plan. It’s essential to understand the implications of switching outside the Medigap Open Enrollment Period, such as potential increases in premium costs or even a denial of coverage.

Therefore, understanding the rules and regulations surrounding enrollment and eligibility is key to making an informed decision about your healthcare coverage. It’s always advisable to seek advice and guidance during the enrollment process to make sure you are making the most suitable choice for your healthcare needs.

If you find understanding the benefits involved with Original Medicare and Medigap Plans challenging, you’re not alone. Whether it’s a Medigap plan, or you want to know more about National General Medicare Supplement Plans in 2025, we can help. Call our team at 1-888-891-0229 for a free consultation or complete the contact form on this site, and an expert will call you back at a convenient time.

We have decades of experience advising our clients on the complexities of Medicare and Medigap plans, the benefits, cost and deductibles. We’ll ensure you get the best rate in your state and advice you can trust.