Rise in Uncompensated Care, Increasing Growth for Medicare Advantage and Access Challenges for Medicaid Beneficiaries Among Predictions for Healthcare in 2025

As we ring in another year, the Belle team has compiled our predictions for 2025. Here is a quick-hitting list of what’s to come for healthcare in the year ahead.

• Uncompensated care will be on the rise, driven by an increase in individuals who are experiencing homelessness, as well as those who have a home but are uninsured.

• Medicare Advantage will continue its growth trajectory, but will not reach default status, at least not yet.

• Reading the political tea leaves, health equity will be significantly deprioritized at the system level. Plans will need to respond accordingly to keep such efforts alive and well.

• Medicare Advantage plans will rebound with innovative ways to offer differentiated benefits. That may include a menu of “member only” a la carte services that will be rationed within a set budget.

• The percentage of Medicare members taking GLP-1 medications will continue to grow, but with lots of strings attached. Plans will expect behavioral or programmatic commitments to qualify and stay on the medication.

• DOGE efforts will hit hard at the immense cost of Medicare fraud, waste, and abuse. Health care claims submissions will be under increased scrutiny leading to a contraction of health costs favoring health plan margins. This may help to bring back lost payer benefits.

• We will see an emerging trend of employers dropping traditional health insurance under the pressure of unmanageable and unsustainable premium increases. Without deregulation and reform, it is just a matter of time before we see the end of employer-sponsored health insurance.

• More individuals will choose to go uninsured and opt for concierge medicine and direct primary care models for their care.

• There will be tightening price controls on therapeutics. As an example, there will be serious debate on whether to allow pharmaceutical companies to sell drugs at cheaper prices abroad than in the U.S.

• Cuts to Medicaid via the Inflation Reduction Act (IRA) provisions could increase out-of-pocket costs for seniors. Reductions in Medicaid could also limit provider participation and available services, potentially leaving seniors without essential care. This threatens to increase the number of individuals who don’t receive appropriate treatment for chronic conditions.

• Resource limitations may impact hospitals’ ability to meet HEDIS benchmarks, which could affect quality scores and funding. Meanwhile, protracted financial challenges will likely lead to additional rural hospital closures, reducing care access for seniors and increasing travel burdens.

Do you agree or disagree with these predictions? Have projections of your own you’d like to share? We’d love to engage in a conversation. Contact our team today!