In 2025, Medicare will undergo some of the most significant changes in a generation. It's going to be an interesting open enrollment because nothing like this has happened in Medicare since the inception of Medicare Part D in 2006. Most result from the Inflation Reduction Act.
1. You Won’t Spend More Than $2,000 for Drug Copays and Coinsurance Under Part D
In 2025, a new approach will replace previous confusing and frustrating Medicare Part Dphases, including the elimination of the infamous “donut hole” and a new hard limit of $2,000 per year for out-of-pocket Part D drug spending.
2. Medicare Advantage Plans That Include Part D May Raise Costs or Reduce Coverage
Medicare Advantage plans that include prescription drug programs (MAPDs) may change or introduce new premiums, formularies, and copays. They may also increase drug deductibles or reduce benefits.
3. You Can Choose to Pay Your Drug Copays and Coinsurance Over Time
In 2025, you can spread out the cost of medications over a period of months rather than paying everything you owe every time you pick prescriptions up from the pharmacy. A new optional payment plan can ease budgeting, particularly for expensive drugs.
4. Part B and Standalone Part D Premiums May Change
Your Part B premium changes every year. In 2025, it will likely increase. And as mentioned above, if you get your benefits from a Medicare Advantage company, those premiums may change.
5. Other Standalone Part D Costs Could Increase
Although most Part D plans sold outside of Medicare Advantage won’t be able to change premiums much in 2025, but you may see new deductibles, and formulary drug tiers could change in makeup and cost.
6. You'll Receive a Mid-Year Notice About Unused Medicare Advantage Benefits
If you're a Medicare Advantage enrollee, you’ll get a new letter in mid-summer 2025. Between June 30 and July 31, 2025, you’ll receive a personalized “Mid-Year Enrollee Notification of Unused Supplemental Benefits.“
7. You'll Have Better Access to Lower-Cost Biosimilar Prescription Drugs
The CMS is finalizing changes to increase Part D insurance providers' ability to make midyear biosimilar drug substitutions for an FDA-approved formulary product.
8. Your Access to Mental Health Professionals May Increase
Starting in 2025, more mental health providers can enroll as Medicare providers, including addiction counselors, licensed mental health counselors (LMHCs), and marriage and family therapists (LMFTs).
9. Medicare Advantage Plans Must Examine the Impact of Prior Authorizations
Almost all Medicare Advantage enrollees must get prior authorization for higher-cost services to manage healthcare usage and lower costs.
The Bottom Line
Medicare changes for 2025 aim to reduce beneficiary medication costs and expand access in various ways. However, everyone’s situation is different. These broad changes may have significant changes to your coverage and costs, or barely impact you. Reviewing your plan for 2025 for anything surprising or worrisome regarding your plan network, drug coverage, or out-of-pocket costs is more important than ever this year.
Article By:
Brian C. Moore - Ohio Medicare Plan - www.OhioMedicarePlan.com - 937.241.5544
