Here’s what you need to know about Medicare open enrollment
Medicare beneficiaries can expect changes to prices and coverage in 2025
Ready, set, go.
The 2025 annual Medicare enrollment period runs from Oct. 15 to Dec. 7. During this time, those who are enrolled can make changes to their coverage, which goes into effect on Jan. 1.
It’s a big deal this year because some significant changes will kick in starting in 2025. Last month, you received your Annual Notice of Change (ANOC) letter laying out upcoming shifts in Medicare Part D prescription drug coverage and costs that will be effective in January. If you’re enrolled in Medicare Advantage, your letter spelled out the upcoming changes to your plan.
My educated guess is that you set it aside, or even tossed it.
Find it.
“It’s particularly important to review your plan this year because of the changes that we're seeing both in terms of plan availability and premiums,” Juliette Cubanski, deputy director of the program on Medicare policy at KFF, told Yahoo Finance.
“I know it can be difficult,” Cubanski said. “There are a lot of plans out there and especially if you take a lot of medications, doing that sort of comparison can seem pretty overwhelming.”
You may think that the plans are pretty much the same, so you’ll stick with what you’ve got. But push yourself to do this exercise.
“We’re seeing some changes not just in terms of premiums, but in terms of cost-sharing, deductibles, and aspects of coverage that could affect both what people pay, but also their ability to access the medications that they need,” she said.
What’s changing in Medicare drug costs and coverage in 2025
1. A new drug cost cap.
In 2025, everyone enrolled in Part D prescription drug plans will have their annual out-of-pocket drug costs capped at $2,000 for co-pays or coinsurance for the prescription drugs their plan covers — a provision in the 2022 Inflation Reduction Act. That’s down from $3,500 this year.
In 2025, Part D plans can have a deductible of up to $590. Then you pay co-payments for your medications until your total out-of-pocket costs reach $2,000.
AARP estimates that 3.2 million Medicare enrollees will reach the $2,000 cap in 2025. By 2029, this number will increase to 4.1 million, or about 10%, of enrollees. It will not apply to Part B prescriptions administered by doctors or any medications not covered by your Part D plan.
According to the analysis, people who reach the cap will save an average of $1,500 in 2025, and an average of 420,000 enrollees will save $3,000 or more between 2025 and 2029.
That’s fantastic in theory.
“This is going to lead to some really significant savings for people who've really been struggling with prescription drug prices,” Leigh Purvis, AARP’s prescription drug policy expert, previously told Yahoo Finance.
But this is business for those Plan D providers. In 2025, for example, plans will pay 60% of Part D drug costs in the catastrophic coverage phase, which starts when enrollees hit the $2,000 out-of-pocket cap. In 2024, the plans covered just 20% of those drug costs, according to KFF’s analysis.
“It's hardly a situation that the drug companies are going to simply say, oh, we'll just pay this money,” Philip Moeller, a Medicare and Social Security expert, told Yahoo Finance.
“They're going to try wherever they can to change the rules. So everybody with a Part D plan has got to be on high alert. They have to look for higher premiums and higher out-of-pocket deductibles. They have to look for reduced coverage of their drugs.”
Your homework: Scrutinize your drug-plan options and the lists of medications covered next year, plus your premiums and co-pays. And compare to other plans in your area.
The Inflation Reduction Act included a 6% cap on base Part D premiums, but the cap does not apply to the total premium that individual plans may charge. The 2025 Part D base premium is $36.78, but actual premiums vary depending on your location and plan, according to the Centers for Medicare & Medicaid Services (CMS).
2. More weight-loss drugs may be covered.
Medicare doesn’t cover drugs prescribed explicitly for weight loss. But Part D plans can cover popular weight-loss drugs when your doctor says you need one for other reasons, such as Ozempic or Wegovy for type 2 diabetes.
Earlier this year, the FDA approved a new use for Wegovy, the blockbuster anti-obesity drug, to reduce the risk of heart attacks and stroke in people with cardiovascular disease who are overweight or obese. For 2025, it’s likely that Part D plans may add the drug to their approved lists.
3. A new way to stretch out paying for your prescriptions.
The Medicare Prescription Payment Plan will let enrollees pay their prescription costs monthly rather than shell out all at once.
This allows you to spread out your out-of-pocket drug costs throughout the year. It doesn’t lower your total cost but certainly can help with your monthly cash flow. To opt into the plan, contact your Part D provider to request a form to choose this option.
4. Medicare Advantage plan changes.
As enrollment in these plans, which are administered by private insurance companies, has exploded, costs for providers have ramped up. Medicare Advantage plans are increasing their deductibles somewhat over 2024 levels, Cubanski said.
It’s a little bit more difficult for people to switch Medicare Advantage plans because that means potentially changing provider networks and doctors.
The reality is that Medicare Advantage insurers have been squeezed due to reimbursement changes from the federal government and rising usage by members. As a result, many experts I interviewed expect plans to become less attractive in 2025. Look for higher out-of-pocket prescription co-pay costs in some plans and reductions or even the elimination of certain benefits.
In 2024, 32.8 million people are enrolled in a Medicare Advantage plan, accounting for more than half, or 54%, of the eligible Medicare population, according to KFF. It's projected to grow to 60% over the next decade.
The average Medicare beneficiary has access to roughly 34 Medicare Advantage plans in 2025.
A big enticement of Medicare Advantage plans is that they typically include coverage for benefits not included in traditional Medicare, such as drug coverage, eyeglasses, dental coverage, and fitness classes. Plus, they often have very low or even no premiums.
But for 2025, experts I spoke to say that some Medicare Advantage plans may reduce their dental and vision coverage and raise co-pays to see specialists. If you signed up for a gym membership through a Medicare Advantage plan, it may not be there in 2025.
It could also get harder to find your preferred doctors and hospitals in Medicare Advantage plans for 2025.
And more than a dozen health systems have reportedly said they’ll stop participating in certain Medicare Advantage plans from major insurers such as UnitedHealth, Humana and Aetna next year.
What to know about Medigap policies
People contemplating moving from an MA plan to traditional Medicare should explore their Medigap options before they switch.
Medigap policies are health insurance policies sold by private insurance companies that pay part or all of certain leftover costs after Medicare pays. They can cover outstanding deductibles, coinsurance, and co-payments and may also cover healthcare costs that Medicare does not cover at all like medical care received when traveling out of the US.
Some traditional Medicare enrollees receive supplemental gap insurance as a retirement benefit from their former employers, and low-income seniors get help from Medicaid.
Many Medigap plans, however, reject applicants with pre-existing conditions if they didn’t sign up when becoming eligible for Medicare initially. People who have not had a private Medigap supplement plan for more than six months may be subject to coverage restrictions.
Medigap plans are not part of open enrollment.
Plans can change 'substantially' from year to year
And there is some good news in that regard this year too. The Centers for Medicare & Medicaid Services (CMS) announced that the average total Part D premium is projected to decrease by $7.45 in 2025, from $53.95 in 2024 to $46.50 in 2025, and to $17 for Medicare Advantage plans, down by $1.23.
Among Medicare Advantage enrollees, more than 4 in 10 did not review their current plan’s coverage to check for potential changes in premiums or other out-of-pocket costs.
And many did not review their plan for potential changes in the kinds of treatments, drugs, and services that would be covered in the following year.
“People are sort of frozen,” Moeller said. “They struggled hard to make their initial Medicare decision. It was hard for them to do. And they said, ‘OK, I've done that.’ And they stick with their plan year in, year out.”
Sure it’s complicated, and most Medicare beneficiaries say they are satisfied with their coverage, but the problem is that few are informed about changes coming in 2025, according according to a recent eHealth survey.
“The reality is that Medicare plans change substantially from year to year, and there's a terrific benefit to actually shopping for your plan,” Moeller said. “My mantra: Give yourself half an hour to save 500 bucks.”
In other words, you better shop around....shop, shop around.
Getting help
The State Health Insurance Assistance Program network (SHIP) provides one-on-one counseling in every state. You can find your local SHIP here.
The Medicare Rights Center offers a free consumer helpline: (800-333-4114.) You can also contact Medicare directly at 800-633-4227 to find Medicare Advantage and Part D Plans in your area and to enroll directly.
Medicare’s online searchable Plan Finder on the Medicare.gov site allows you to review Medicare plan options. Every fall before open enrollment, Medicare loads all of the private plan data into this tool, including Part D drug plans, private Medicare Advantage plans, and even the Medigap plans, which are run by the states.
If you have a limited income, you might be eligible for Medicare’s Extra Help, which covers Part D premiums and deductibles and caps drug costs.
Keep in mind, too, that there could be less expensive alternatives for the drugs you're taking, so it's always good to have conversations with your physician to see if there is an alternative covered by your plan, Purvis said.
Reach for the stars
Medicare Star Ratings can help you see how different plans compare. Star ratings can be found using Medicare’s Plan Finder tool. New plan quality ratings come out each October.
The Star Ratings system developed by the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and prescription drug (Part D) plans on a 5-star scale. Ratings focus on health plan quality based on measurements of customer satisfaction and the quality of care a plan delivers.
Kerry Hannon is a Senior Columnist at Yahoo Finance. She is a career and retirement strategist, and the author of 14 books, including "In Control at 50+: How to Succeed in The New World of Work" and "Never Too Old To Get Rich." Follow her on X @kerryhannon.
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