Niche Medicare Plans for Poor, Unhealthy at Risk Under New Rule

Unease is building among smaller, nonprofit Medicare managed care plans as they digest the impact of next year’s program payment rates.

The private Medicare Advantage “safety-net plans” say their 2025 payment rates won’t match the rising costs of serving some of the program’s most vulnerable beneficiaries.

Dual Eligible Special Needs Plans, or “D-SNPs,” are MA plans that serve a portion of the estimated 12 million sick, low-income beneficiaries with costly, complex medical needs who also qualify for Medicaid.

Payments to MA plans will increase 3.7% on average in 2025, according to a recent final rule. But that amounts ...