Medicare in Flux: What Florida’s October 2025 Policy Shifts Mean for Physicians
Medicare in Flux: What Florida’s October 2025 Policy Shifts Mean for Physicians
As of October 2025, Florida physicians are navigating significant changes in Medicare policies that impact reimbursement structures, telehealth regulations, and patient care models. These shifts necessitate prompt adaptation to maintain compliance and optimize practice operations.
🏥 Medicare Payment Adjustments
A notable development is the proposed 3.8% increase in Medicare payments for 2026, contingent upon physician participation in qualifying alternative payment models (APMs). Physicians not engaged in APMs would receive a 3.3% increase. This adjustment aims to address the historical underinvestment in primary care and prevention, with potential benefits for specialties like family medicine, geriatrics, and psychiatry, which frequently utilize timed billing codes Axios.
📞 Telehealth Policy Changes
Effective October 1, 2025, Medicare's telehealth flexibilities have expired, reinstating previous in-person requirements for mental health services. Patients must have received an in-person Medicare-covered mental health service within six months prior to the first telehealth session and at least once every 12 months thereafter. Exceptions apply for patients in rural areas or those receiving treatment for substance use disorders or co-occurring mental health conditions Telehealth Resource Centers.
Additionally, the federal government shutdown has led to the expiration of temporary telehealth and hospital-at-home programs, affecting over 4 million Medicare beneficiaries. This disruption has forced some physicians to halt telemedicine visits, even for non-Medicare patients, due to the uncertainty in coverage Stateline.
🧾 Medicare Advantage Plan Changes
Physicians should be aware of modifications in Medicare Advantage plans, including network adjustments and benefit alterations. For instance, First Physicians Group in Florida announced that, effective July 1, 2025, its primary care physicians will no longer participate in any Blue Cross and Blue Shield Medicare Advantage plans. However, specialty services and inpatient/outpatient care at Sarasota Memorial Health Care System remain in-network First Physicians Group.
🧠 Mental Health Services Access
The expiration of telehealth waivers has implications for mental health service delivery. Physicians must assess their patient populations to identify those affected by the in-person service requirements and determine eligibility for exceptions. Planning for in-person visits and coordinating care within group practices may be necessary to comply with the new regulations Telehealth Resource Centers.
🗓️ Open Enrollment Period
Medicare Open Enrollment begins on October 15, 2025, and ends on December 7, 2025. During this period, beneficiaries can compare 2026 coverage options on Medicare.gov. Physicians should be prepared to assist patients in understanding how these changes may affect their coverage and out-of-pocket costs CMS.
🔄 Strategic Recommendations for Physicians
Evaluate Participation in APMs: Consider engaging in alternative payment models to benefit from the proposed payment increases and align with value-based care initiatives.
Review Telehealth Practices: Ensure compliance with the reinstated in-person requirements for mental health services and prepare for potential disruptions in telehealth services.
Monitor Medicare Advantage Plans: Stay informed about network changes and assist patients in navigating plan modifications to maintain continuity of care.
Prepare for Open Enrollment: Educate patients about new coverage options and out-of-pocket cost changes to facilitate informed decision-making.
In conclusion, Florida physicians must remain agile and informed to effectively navigate the evolving Medicare landscape. Proactive engagement with these policy changes will ensure continued delivery of high-quality care to Medicare beneficiaries.
