National General Medicare Supplement 2025 – Plans & Rates

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Russell Noga
by Russell Noga | Updated April 6th, 2024

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


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Exploring National General's Medicare Supplement Plans for 2025

Exploring National General's Medicare Supplement Plans for 2025


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.



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Understanding Coverage: Supplement vs. Medicare Advantage Plans

Understanding Coverage Supplement vs. Medicare Advantage Plans


When it comes to your health, every decision counts, especially when choosing between Medicare Supplement and Medicare Advantage plans. Understanding the differences between these two types of plans can help beneficiaries make an informed decision about their healthcare coverage.

Medicare Supplement plans offer beneficiaries the flexibility to choose any doctor or specialist that accepts Medicare without requiring a referral. On the other hand, Medicare Advantage plans often limit enrollees to a network of providers and may require referrals to see specialists.

With Medicare Supplement plans, enrollees pay fixed monthly premiums in addition to their regular Medicare premiums. These supplements cover costs such as Part A and B deductibles, copays, and coinsurance. Conversely, Medicare Advantage plans may offer lower or zero premiums but still require copayments, coinsurance, and deductibles, and these plans are subject to change annually. In this context, it’s essential to consider the Medicare cost plan program as an alternative option for coverage.

Medicare Advantage plans often include:

  • Part D prescription drug coverage
  • Additional benefits such as vision, dental, and hearing coverage
  • An annual out-of-pocket maximum which limits total expenditure within a year

In contrast, Medicare Supplement plans do not automatically include these extra benefits but may cover state-mandated benefits not required by Medicare Advantage plans.


Staying Informed: Resources and Support for Medicare Beneficiaries

Information is power, especially when it comes to healthcare. CMS provides various resources and support for Medicare beneficiaries to stay informed about their coverage options. It’s essential for beneficiaries to understand their coverage or benefits fully to make informed decisions.

Unfortunately, hospitals and health systems often encounter Medicare beneficiaries who lack an understanding of their coverage or benefits. Some may have chosen a Medicare Advantage plan without full knowledge of the implications. To address this, the American Hospital Association supports CMS’ efforts to ensure that seniors can make informed decisions by having access to accurate and complete information about their Medicare coverage options.

CMS has proposed new guardrails aimed at preventing financial incentives for agents or brokers from steering consumers to certain plans. These measures ensure seniors receive complete and accurate information, helping them make the best healthcare decisions for their needs.

Furthermore, it’s important to note that Medicare Supplement plan enrollees benefit from the ability to retain their coverage even if they move out of state. In contrast, Medicare Advantage plans may lose coverage outside the original service area.



In conclusion, understanding the changes in Medicare Advantage policies for 2025 and how they impact Medicare Supplement plans is key for beneficiaries. National General is committed to aligning with these updates and ensuring compliance with industry standards. It’s essential to understand enrollment and eligibility rules and differences between Medicare Supplement and Medicare Advantage plans and to stay informed about coverage options. The best healthcare decisions are made when armed with accurate and complete information.

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Frequently Asked Questions

What is the donut hole for 2024?

In 2024, the donut hole for Medicare Part D will be reached when you and your plan have paid $5,030 for your medications. This is when your total drug costs exceed the initial coverage period threshold.


  What are the proposed CMS Commission changes for 2025?

The proposed CMS Commission changes for 2025 include a strategic redesign of Dual Eligible Special Needs Plans, protection of beneficiaries from anti-competitive sales and marketing activities, and expanded access to high-impact supplemental benefits. Additionally, there are updates to the Part D risk adjustment model to reflect the redesign of the Part D benefit as required by the IRA, including the increase in plan liability and the new Manufacturer Discount Program.


  What is the CMS rate announcement for 2025?

The CMS rate announcement for 2025 predicts an average increase of 3.70% in payments from the government to MA organizations, with an expected net impact of $9.2 billion on the Medicare Trust Funds. This announcement takes into account the impact of the benchmark rate cap, MA rebate, and other policies.


How is National General adapting to CMS updates for 2025?

National General is adapting to CMS updates by making changes to risk adjustment models, network adequacy standards, broker compensation, and health equity initiatives in order to align with the 2025 updates.


What are the eligibility requirements for Medicare supplement insurance?

In order to enroll in Medicare Supplement insurance, you need to have Medicare Part B. This is a crucial eligibility requirement.

Speak to the Professionals about Medigap Plans and Original Medicare

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.

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