Medicare open enrollment for 2025 is from October 15 to December 7. There are five types of Medicare plans, including Part A, B, C, D, and Supplemental. Now is the time to contact a Medicare specialist to learn more about any changes to your current plan and to look into alternatives for Part C (Medicare Advantage plans), Medicare supplemental insurance plans, or Part D, prescription drug coverage. In addition, learn what changes Congress made to Medicare for 2025.

What are some of the changes to Medicare in 2025?

It is anticipated that Medicare Part B and Part D premiums will rise.  Fortunately, the Centers for Medicare Services (CMS) announced a voluntary, nationwide, one-year “demonstration” or experiment to help stabilize premiums for standalone Part D plans.  The one-year “demonstration” allows the CMS to test the program and extend or ramp up later.  Participating plans get money from the government to help contain premium costs.  Any plan that chooses to participate for two years can only increase their Part D premium to $35 in 2025.

Another change in 2025 allows a person to spread out the cost of medication over months rather than paying for everything when picking up their prescription.  Paying over time can ease budgeting for someone.  Though it is unclear how this payment plan will work, it will likely be coordinated with the person’s Medicare Part D provider.

Lastly, there should be more access to mental health. More qualified mental health providers can enroll as Medicare providers, including addiction counselors, licensed mental health counselors, and marriage and family therapists.   This step hopes to broaden verified covered services, specialists, and combat providers that have left the network or are not taking new clients.

Are there changes to Medicare Part D plans?

There are changes to Medicare Part D plans. 2025 eliminates the infamous “donut hole” in Medicare Part D.  Instead, there is a new hard limit of $2,000 per year for out-of-pocket Part D-covered drug spending.  There are phases for people to reach this new deductible:

1. If there is a deductible, a person will pay 100% of their prescription drug costs until they spend $590, the Part D deductible for 2025.
2. After meeting the deductible, a 25% coinsurance will apply for covered drugs until $2,000 is paid out-of-pocket.
3. Once a person has paid $2,000 out-of-pocket for Medicare Part D’s covered medications, they will not pay anything else for 2025.  Please note that this $2,000 limit will increase due to inflation.

Unfortunately, the $2,000 deductible does not apply to drugs not covered.  Furthermore, Part B drugs provided by a medical professional in an outpatient hospital setting, such as injections (i.e., chemotherapy), do not apply to the $2,000 deductible. (AARP)

Any changes to the Medicare Advantage plans?

Medicare Advantage plans that include prescription drug programs may introduce or change their premiums, formularies, and co-pays.  Changes may affect covered medications, their doctor, or other providers by increasing drug deductibles or reducing benefits. Medicare partly funds Medicare Advantage plans.  Therefore, the $2,000 Part D deductible and the limited increase in government payments for 2025 are sparking these changes.  It is best to check with your plan for any changes.

Another change to Medicare Advantage plans is enrollees will receive a personalized letter in mid-summer (between June 30 and July 31) called “Mid-Year Enrollee Notification of Unused Supplemental Benefits.”  This letter will include any supplemental benefits (vision and dental) that have not been used within the first six months of coverage and include:

• The benefit’s scope
• Cost-sharing for the benefit
• Instructions on how to access the benefit
• Network information
• Customer service number to call for more information

The letter addresses any unused benefits and unspent funds to help avoid monies going back into Medicare Advantage marketing efforts rather than providing benefits.

Are there any new programs?

In 2025, a new program called Guiding an Improved Dementia Experience (GUIDE) will offer services to people with dementia and their unpaid caregivers to keep patients at home longer.

Who should consult during open enrollment for Medicare 2025?

Consult any health insurance agent/broker who specializes in Medicare coverage. If you need help finding a Medicare Agent, reach out to STAGES.  Another option is contacting HICAP (Health Insurance Counseling and Advocacy Program). HICAP is a government agency that helps people on Medicare understand their Medicare benefits and options. Visit the California Health Advocates’s website to find your local HICAP office.

STAGES is here to educate people during Medicare open enrollment..