Medicare AdvantageCoverageHigh impact
2025 Medicare changes
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, General Practice +1 more·Provider Update
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage plans are implementing significant benefit changes for 2025, including $0 copays for all PCP visits, new tiered cost sharing structures, and changes to radiation therapy coinsurance (20%). Several plans are being eliminated or restructured, and transportation/Papa Pals benefits are being removed from most plans.
Action Required
By January 1, 2025: Billing team must update copay collection procedures to reflect $0 copays for all PCP visits (including sick visits) for Medicare Advantage members. Update radiation therapy billing to reflect 20% coinsurance instead of copays. Verify member eligibility and benefits for all patients as plan structures have changed significantly. Front desk staff must check member benefits for tiered cost sharing before scheduling ASC/outpatient hospital services. Update telemedicine billing to apply same copays as in-office visits.