Medicare, the government-run healthcare program for those aged 65 and older, as well as those with certain disabilities, is set to undergo several changes in 2025. Medicare beneficiaries can expect to see several changes to the program that will impact their healthcare coverage and costs. These changes were enacted as part of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 and aim to improve healthcare quality, increase access to care, and control costs.

Firstly, one of the significant changes that are set to take place is the introduction of the Medicare Advantage hospice benefit. Currently, Medicare covers hospice services under the traditional fee-for-service program. However, in 2023, Medicare Advantage plans will be able to offer a hospice benefit. This means that patients will be able to receive hospice care through their Medicare Advantage plan, rather than having to enroll in the traditional fee-for-service program. The aim of this change is to make it easier for patients to access hospice care and improve the coordination of care between different providers.

Another change that is set to take place in 2025 is the expansion of telehealth services. During the COVID-19 pandemic, there was a significant increase in the use of telehealth services, and this trend is set to continue in 2023. Medicare will expand coverage of telehealth services to include mental health counseling, home health visits, and annual wellness visits. This change will make it easier for patients to access care from the comfort of their own homes, which is particularly important for those who are unable to leave their homes due to mobility issues or other health concerns.

One of the most significant changes coming to Medicare in 2025 is the implementation of a new payment model for doctors and other healthcare providers. The Medicare Access and CHIP Reauthorization Act (MACRA) created the Merit-Based Incentive Payment System (MIPS), which rewards providers for delivering high-quality care while also controlling costs. MIPS consolidates and replaces several existing programs, including the Physician Quality Reporting System, the Value-Based Payment Modifier, and the Medicare Electronic Health Record Incentive Program.

Under MIPS, providers will be evaluated based on four categories: quality, cost, improvement activities, and promoting interoperability. Each category is weighted differently, with quality accounting for the highest percentage of a provider's score. Providers who score well on these measures will receive a financial bonus, while those who score poorly may see a reduction in payments.

While MIPS is designed to incentivize providers to deliver high-quality, cost-effective care, some experts worry that it may lead to decreased access to care for some beneficiaries. Providers may be less willing to treat patients who have complex medical needs or who are more costly to treat, as these patients may lower their MIPS scores and impact their financial incentives.

Another change coming to Medicare in 2025 is an increase in the income thresholds for high-income beneficiaries. Currently, individuals with an income of $88,000 or more and couples with an income of $176,000 or more pay higher premiums for Medicare Part B and Part D. In 2025, these income thresholds will increase to $91,000 for individuals and $182,000 for couples. This means that more beneficiaries may be subject to higher premiums.

In addition, Medicare will also expand coverage of innovative medical technologies in 2025. This includes coverage for medical devices that are approved under the FDA's breakthrough device program. The breakthrough device program is designed to accelerate the development and review of medical devices that provide more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions. The expansion of coverage for these innovative medical technologies means that patients will have access to new treatments and technologies that could improve their health outcomes.

Another change coming to Medicare in 2025 is the introduction of the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. This model is designed to improve the quality of care for patients with ESRD and reduce healthcare costs. The ETC model will test different payment and service delivery models for patients with ESRD to determine which models provide the best outcomes for patients. The aim of this change is to improve the coordination of care for patients with ESRD and ensure that patients receive the best possible care.

Furthermore, there will be changes to Medicare's Part D prescription drug program in 2025. Medicare will cap the amount that beneficiaries pay for insulin at $35 per month. This change is aimed at reducing the cost of insulin for patients, which has been a significant concern in recent years. In addition, there will be changes to the way that Medicare calculates the true out-of-pocket (TrOOP) costs for beneficiaries. This will make it easier for beneficiaries to reach the catastrophic coverage phase of the Part D program, where they will pay significantly less for their medications.

Finally, Medicare will also introduce changes to the way that accountable care organizations (ACOs) are reimbursed. ACOs are groups of healthcare providers who work together to coordinate care for patients. Medicare will change the way that ACOs are reimbursed to reward those that provide high-quality care and reduce costs. This change is aimed at improving the quality of care that patients receive and reducing healthcare costs.

Overall, the changes coming to Medicare in 2025 represent a significant shift in the program's approach to healthcare delivery and payment. While they aim to improve healthcare quality and control costs, it remains to be seen how these changes will impact beneficiaries' access to care and out-of-pocket costs. It will be important for beneficiaries to stay informed about these changes and how they may affect their healthcare coverage and costs.