The Medicare Advantage landscape is shifting again. With more than half of all Medicare beneficiaries now enrolled in an MA plan, the Centers for Medicare & Medicaid Services (CMS) has finalized new rules for 2025 that aim to strengthen patient protections, improve access, and hold plans more accountable.

While these updates are largely directed at insurers, physicians who contract with MA plans or care for a high volume of MA patients will feel the ripple effects. From prior authorization reforms to new requirements around continuity of care, the final 2025 Medical Advantage (MA) and Part D rule raises expectations for how plans operate and how care is delivered across the board.

The CMS is formalizing its push for health equity by adding it directly into how plans are measured. A new Health Equity Index (HEI) will become part of the MA Star Ratings system, rewarding plans that show measurable improvements for enrollees with social risk factors. On top of that, equity-focused initiatives will now be required as part of each plan’s quality improvement strategy.

For physicians, especially those in value-based care arrangements, this shift could translate to more opportunities to screen for social needs and improve outcomes among vulnerable populations.

In response to growing frustration from providers and patients, the CMS is rolling out new requirements that bring more transparency and standardization to prior authorization. Starting in 2025, MA plans will need to publicly post their authorization policies and clearly define how medical necessity is determined. These decisions must rely on established clinical guidelines and not just a plan’s internal rules.

The CMS has also shortened the clock: standard requests must be answered within 7 days, and expedited ones within 72 hours. Perhaps most importantly, once approved, authorizations must remain valid for the entire course of treatment, removing the need for reapproval of mid-care. These changes are intended to cut down on delays, reduce administrative tug-of-war, and improve continuity for patients.

The CMS is also tightening expectations around how plans handle utilization management and appeals. Under the new rule, plans must publicly share the criteria they use for coverage decisions and make the appeals process clearer and more accessible.

The aim is to reduce the time physicians spend disputing vague denials and to ensure that patients get a fair, consistent review when coverage is in question. Fewer gray areas, more predictability and ideally, a lot less paperwork.

Under the 2025 rule, MA plans are now required to put clear continuity of care policies in place. That means patients should be able to maintain access to ongoing treatments, even if their coverage changes or their provider exits the network mid-course. This safeguard is especially important during transitions between plan years or shifts in insurance status. For physicians, it offers added protection against sudden treatment disruptions due to network changes.

Even though these rules are aimed at insurers, they impact how practices coordinate care, document services, and advocate for patients. To stay ahead of the changes: