It’s crucial for individuals to compare plans during Medicare open enrollment from Oct. 15 to Dec. 7, especially this year due to upcoming changes in Medicare Advantage plans and Medicare Part D prescription drug plans. It’s essential to understand how your plan will cover you in 2025.
According to a 2022 survey from health policy nonprofit KFF, only about half (54%) of Medicare Advantage members review their plan’s coverage information to see what changes are coming for the next year.
Certified financial planner and licensed insurance agent Kari Vogt emphasizes the importance of reviewing your plan every year, even if you don’t change it annually.
Reasons to Review Your Medicare Plan
Here are three reasons why you should take the time to review your Medicare paperwork this fall.
New Part D Cap
Starting in 2025, Medicare Part D prescription drug plans will cap consumers’ out-of-pocket spending at $2,000. However, this cap applies only to drugs covered by your plan, and plans can change their coverage annually.
Meredith Freed from the KFF Program on Medicare Policy warns that Part D plan sponsors may alter the list of covered drugs and cost-sharing tiers each year. Premiums may also increase, particularly for stand-alone Part D plans.
This change also impacts Medicare Advantage plans with prescription drug coverage. It’s crucial for everyone to review the terms when plans send their Annual Notice of Change in the fall.
Melinda Caughill, CEO of 65 Incorporated, advises individuals to carefully review the document containing the plan updates for 2025, as it will provide links to the formulary list.
After reviewing your plan’s updates, visit Medicare.gov to enter your prescription drugs and dosage in the plan finder to explore other available options for Medicare Advantage or Part D. Consider the total out-of-pocket cost on each plan and be aware that uncovered drugs will require full payment out of pocket.
If one of your costly drugs won’t be covered next year, consult your doctor to explore alternative options. Caughill emphasizes that having a $0-premium drug plan could still result in a $20,000 annual expense if your medications are not covered.
If you would like immediate assistance from a licensed insurance agent, please reach out to the number provided.
When it comes to Medicare Advantage providers, there is a possibility that benefits may be reduced in 2025 due to financial challenges. This could mean increased cost sharing or a reduction in the scope of coverage. It is essential to review the plan documents to understand the changes and explore other options that may better suit your needs.
If you have concerns about your coverage in 2025, you can seek assistance by contacting 800-MEDICARE or reaching out to your State Health Insurance Assistance Program (SHIP). Speaking with a knowledgeable representative can help clarify any changes to your plan and determine if it still aligns with your preferences.
Additionally, some Medicare Advantage companies are discontinuing certain plans in 2025, and in some cases, withdrawing from entire states. If your plan is being discontinued, you can either switch to another Medicare Advantage plan in your area or revert to Original Medicare. Returning to Original Medicare gives you the opportunity to enroll in a Medicare Supplement Insurance plan without undergoing medical underwriting.
It is crucial not to overlook your coverage renewal and carefully evaluate any changes. Understanding the terms of your provider’s plan is essential, and taking the time to review and compare options is necessary to ensure you have the most suitable coverage. content using different words.
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