AARP Online Community and Discussion Forums - CMS orders Medicare Advantage plans to disclose pr...

GailL1 · ‎09-19-2025

I’d say this is a good move and one that should benefit those with a Medicare Advantage plan - but remember they do have 30 days to make any changes from the date they are aware of them. Providers can go in and out of network at different times since their contracts with the insurer are signed at different times.

When seeing a new provider it is always a good idea just to double check with their office that they are providers in your insurance network group - that’s for any kind of insurance - even Traditional Medicare.

ModernHealthcare.com 09/18/2025 - CMS orders Medicare Advantage plans to disclose provider networks

My access to this ModernHealthcare source is limited so I am posting it only as a summary but also I am posting the CMS final rule that is in the Federal Registry -

From the Modern Healthcare link -

Medicare Advantage insurers will be required to submit provider directories to the Centers for Medicare and Medicaid Services next year under a final rule issued Thursday. CMS intends to incorporate provider network information into the Medicare Plan Finder portal. This policy builds on a plan the agency announced last month to assemble provider lists it will add to the plan finder for the upcoming annual enrollment period. Insurer participation in that initiative is voluntary. CMS eventually aims to create a national provider directory. (Early, 9/18)

Federal Register - 09/19/2025 - Published Document: 2025-18236 (90 FR 45140)

Department of Health and Human Services Centers for Medicare & Medicaid Services

42 CFR Part 422
[CMS-4208-F2]
RIN 0938-AV40

This final rule implements Medicare Advantage disclosure requirement changes.

Effective date: These regulations are effective November 17, 2025.

Applicability date: This final rule is applicable beginning January 1, 2026.

I. Executive Summary

A. Purpose

The primary purpose of this final rule is to amend the regulations pertaining to disclosure requirements under 42 CFR 422.111 for the Medicare Advantage (MA) (that is, Part C) program. In this final rule, CMS is finalizing a new requirement that will increase beneficiaries' access to provider data while comparing plans in the CMS Medicare Plan Finder (MPF) tool, which will contribute to the beneficiaries' ability to make more informed decisions about their health care.

B. Summary of the Provision—Format Provider Directories for Medicare Plan Finder

CMS is finalizing the proposed requirement for MA provider directory data to be submitted to CMS/HHS for publication online in accordance with guidance from CMS/HHS.

In addition, CMS is finalizing the proposal that MA provider directory data be updated within 30 days of the date an MA organization becomes aware of changes to that data.

CMS is also finalizing the proposal to require MA organizations to attest at least annually that the MA provider directory information is accurate when the attestation is provided to CMS.

These regulatory changes will further promote informed beneficiary choice and transparency found in online resources, empowering people with Medicare to make informed choices about their coverage.

CMS is not finalizing the portion of the proposal that would have required MA organizations to attest that their MA provider directory data are consistent with data submitted to comply with CMS's MA network adequacy requirements under § 422.116(a)(2)(i). MA organizations already attest that they have an adequate network for access and availability of a specific provider or facility type.

There is more on the Federal Registry pertaining to this rule change - see the above link .

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