MACRA was signed into law in 2015, largely affecting how providers are paid for providing care. This primarily impacted Medicare supplement plans (Medigap).
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was an act of Congress that made many changes to the U.S. healthcare system, including Medicare. For beneficiaries, the biggest changes involved Medigap plan options and costs for Part B and Part D premiums.
As a result of MACRA, Medigap Plan C and Plan F are no longer available to Medicare beneficiaries who became eligible on January 1, 2020.
Further, MACRA regulations added an additional income bracket to the payment structure for Part B and Part D premiums.
In April 2015, MACRA was signed into law. MACRA made several changes to both Medicare and the Children’s Health Insurance Program (CHIP). Most of these started between 2018 and 2020.
There are several aims of MACRA, including:
- reducing Medicare spending
- increasing accountability for healthcare facilities
- encouraging high quality care
- discouraging unnecessary doctor’s visits
Major changes include new rules about the payments and reimbursements physicians receive from Medicare.
The law affects different parts of Medicare, so your experience with MACRA regulations will depend on which parts you use.
Medicare supplement insurance plans, often called Medigap, are plans from private insurance companies that help cover some out-of-pocket costs of Parts A and B.
There are 10 different Medigap plans, and each offers slightly different coverage. Commonly covered costs include:
- Part A deductible
- Part A coinsurance costs (including those for hospital and skilled nursing facility stays)
- Part B coinsurance costs
- emergency medical care while traveling abroad
Medigap plans saw the biggest changes under MACRA. One goal of MACRA was to reduce unnecessary doctor visits, which in turn will reduce overall Medicare spending.
To achieve this goal, MACRA regulations state that Medigap plans are no longer allowed to offer coverage for the Part B deductible, which is $257 in 2025.
This means that as of January 1, 2020, Medigap plans that include Part B deductible coverage can no longer be sold. The affected plans are:
- Medigap Plan C
- Medigap Plan F
- Medigap Plan F (high deductible)
However, this rule only applies to Medicare beneficiaries who became eligible after December 31, 2019. Even if you didn’t already have a Medigap plan, you can still buy or keep Plan C or Plan F if you were eligible for Medicare before 2020.
Medicare Advantage (Part C) plans are sold by private insurance companies that contract with Medicare to provide coverage. They cover the same basic services as Part A (hospital insurance) and Part B (medical insurance), which are often called Original Medicare.
Medicare Advantage plans have their own pricing and networks, and many cover services that Original Medicare doesn’t. Advantage plans can also vary depending on where you live and the insurance company you choose.
The effects of MACRA on Medicare Advantage are still developing. Most initial rules weren’t made with Advantage plans in mind.
However, some parts of MACRA might make changes to Medicare Advantage, including:
- Merit-based incentive payment systems (MIPSs): Under MIPS, healthcare providers are reimbursed at a higher rate for high quality care. Providers receive bonuses for meeting quality goals.
- Alternative payment models (APMs): Like MIPS, APMs reward facilities for quality patient care. With an APM, providers are not paid under Medicare’s traditional fee-for-service approach but with a mix of different models. A 5% bonus is given yearly to participating facilities.
Medicare-approved providers can choose the path in which they wish to participate. As MACRA continues to be rolled out, Medicare Advantage plans might be considered an APM. If this happens, prices and plan offerings for Medicare Advantage might see some changes.
Part B and prescription drug (Part D) plans come with monthly premiums.
Part B has a standard premium of $185 in 2025, while Part D premiums are based on your chosen plan. However, you’ll pay more in premiums for both parts if you have a high income.
If you have a higher income, you’ll pay an additional premium surcharge. This added fee is called an income-related monthly adjustment amount (IRMAA).
Any IRMAA you have will be based on your gross income from your income tax return 2 years ago. For example, 2025 rates are based on your 2023 filing.
Before MACRA, there were five income brackets. MACRA added a sixth income bracket in 2018.
The brackets have changed slightly in 2025 to adjust for average incomes in the United States. The current income brackets and Part B premiums are as follows:
| Individual income | Joint filed (married) income | separately filed (married) income | Part B monthly premium |
|---|---|---|---|
| up to $106,000 | up to $212,000 | up to $106,000 | $185 |
$106,000-$133,000 | $212,000-$266,000 | not applicable | $259 |
| $133,000-$167,000 | $266,000-$334,000 | not applicable | $370 |
$167,000-$200,000 | $334,000-$400,000 | not applicable | $480.9 |
| $200,000-$500,000 | $400,000-$750,000 | $106,000-$394,000 | $591.9 |
| $500,000 or above | $750,000 or above | $394,000 or above | $628.90 |
Income brackets for the Part D premium in 2024 are as follows:
| Individual income | Joint filed (married) income | Separately filed (married) income | Part D monthly premium |
|---|---|---|---|
| $106,000 or less | $212,000 or less | $106,000 or less | your plan’s premium |
$106,000-$133,000 | $212,000-$266,000 | not applicable | $13.70 + your plan premium |
$133,000-$167,000 | $266,000-$334,000 | not applicable | $35.30 + your plan premium |
| $167,000-$200,000 | $334,000-$400,000 | not applicable | $57.00 + your plan premium |
| $200,000-$500,000 | $400,000-$750,000 | $106,000-$394,000 | $78.60 + your plan premium |
| $500,000 or above | $750,000 or above | $394,000 or above | $85.80 + your plan premium |
While many MACRA regulations affect healthcare providers, Medicare beneficiaries will also notice a few changes. If you’ve been enrolled in Medicare for a while, changes that could affect you include:
- a new Medicare card without your social security number displayed on it
- a change to your IRMAA for Part B and Part D premiums if your annual income is over a certain threshold
If you first became eligible for Medicare in 2020, the change that affects you the most is around Medigap plan offerings.
Medigap plans are no longer allowed to cover the Part B deductible, so you won’t be able to buy Plan C, Plan F, or Plan F (high deductible). You can still purchase those plans if you were eligible for Medicare on December 31, 2019 or earlier.