REMINDER: Continuity of care: CMS 90-day rule reminder.

Ensuring seamless transitions for members switching plans

As a reminder, the 2024 Medicare Advantage Final Rule requires coordinated care plans to provide a 90-day transition period when a Medicare beneficiary currently undergoing an active course of treatment switches to a new Medicare Advantage plan. This includes new members enrolling in Martin’s Point Generations Advantage plans or a current Generations Advantage member enrolling in a Medicare Advantage plan offered by another insurance carrier for 2026:contentReference[oaicite:1]{index=1}.

During this transition period, the new plan is prohibited from requiring prior authorization for an active course of treatment that started prior to the member joining the new plan. This requirement can be found at 42 CFR § 422.212(b)(8).

After the 90-day transition period, the plan may reassess medical necessity and apply out-of-network limits in accordance with plan benefits and other relevant (and appropriate) requirements. For example, if the active course of treatment included visits with an out-of-network provider, after 90 days, the plan may direct care to in-network providers and apply prior authorization requirements.