Upcoming Changes for Dually Eligible Individuals—the Final 2025 Medicare Advantage Rule July 31, 2024

In April, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that will affect how dually eligible individuals access Medicare Advantage plans and Medicare benefits. The rule changes:

• When individuals can switch plans

• When individuals can switch from Medicare Advantage to Traditional Medicare

• Which individuals can enroll in certain Dual-Eligible Special Needs Plans (D-SNPs).

In addition, the rule improves how Special Supplemental Benefits for the Chronically Ill (SSBCI) are administered, limits D-SNP “look-alike plans” that are not subject to the same enrollee protections as D-SNPs and implements network standards for mental health and substance use disorder services.

Who Should Participate: Advocates working with dually eligible individuals on health care issues.