Medicare AdvantageCoverageHigh impact
2025 Medicare changes
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, General Practice +3 more·Provider Update
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Effective January 1, 2025, BCBSRI Medicare Advantage plans implemented significant changes including $0 copays for all PCP visits, telemedicine cost sharing matching office visits, new tiered cost sharing for ASC/outpatient hospital services, and radiation therapy moving to 20% coinsurance. Additionally, 470 drugs were removed from formulary with 936 drugs moving to higher tiers, requiring prior authorization or coverage exceptions for affected medications.
Action Required
Immediately: Update billing system to reflect $0 copays for all PCP visits and match telemedicine copays to office visit copays for BCBSRI Medicare Advantage members. Verify member benefits for tiered cost sharing before scheduling ASC/outpatient procedures. Update radiation therapy billing to reflect 20% coinsurance. For pharmacy: Review patient medications against updated formulary and submit coverage exceptions through Prime Therapeutics for drugs moved off formulary or to higher tiers. Transition fills available for first 90 days of 2025.