Minneapolis, MN – With big changes expected for Medicare Advantage and Part D prescription drug coverage for 2025, medicareresources.org is advising seniors to pay close attention to their mail leading up to the annual Medicare open enrollment period this fall.
Many seniors may discover that their current Medicare plans are ending or that benefits and costs are shifting due to new federal rules. They also will learn that their Part D prescription drug coverage – which 80% of Medicare beneficiaries have – will cap out-of-pocket costs at $2,000 in 2025.
Such changes will be noted in Plan Annual Notice of Change (ANOC) letters, due to hit mailboxes by late September, before Medicare open enrollment begins on Oct. 15. Beneficiaries should also receive a separate “Evidence of Coverage” form with additional details about what their plan covers and how much they pay.
“Big changes are coming for many Medicare beneficiaries, and in some cases, people will need or want to enroll in a new plan,” said Louise Norris, a health policy analyst for medicareresources.org. “So, it’s more important than ever to pause before tossing out what you think is junk mail. A deluge of Medicare-related mail is on its way, and it won’t all be marketing promotions from insurers. Pay close attention to mail from Medicare and your current plan provider.”
Norris is the author of medicareresources.org’s “Medicare Open Enrollment 2025 Guide.” During Medicare open enrollment – also known as the Annual Election Period – 67.4 million Medicare enrollees can choose a different Medicare Advantage or Medicare Part D plan, or switch between Original Medicare and Medicare Advantage. The enrollment period ends Dec. 7.
“If an enrollee needs or wants to make a change, take action early,” advised Jenny Chumbley Hogue, a health policy analyst for medicareresources.org. “Compare plans and shop around now so you can stay covered and avoid potential late-enrollment penalties.”
Among the notifications that enrollees should watch for: Half a dozen carriers offering Medicare Advantage and Part D plans for Original Medicare beneficiaries are withdrawing from markets. Others are limiting plan options, increasing premiums and/or cutting back on benefits for 2025.
Medicare Advantage funding prompts changes
Since 2018, total Medicare estimated payments to Medicare Advantage plans have doubled. For 2025, the Centers for Medicare & Medicaid Services (CMS) revised rates for Medicare Advantage plans that reduce how much the plans are paid to cover their enrollees.
“We’re already seeing how these upcoming cutbacks are impacting what Medicare Advantage insurers will offer enrollees for 2025,” said Chumbley Hogue. “Some insurers are reducing benefits they offer or cutting plans altogether.”
About half of America’s 67.4 million Medicare beneficiaries are enrolled in Medicare Advantage.
“Read these notices carefully. Make sure you understand whether your plan is continuing and if there are changes – whether it’s a change in premium, dental or prescription coverage, or other benefits,” advised Chumbley Hogue. “You don’t want to find out too late your plan has been discontinued or no longer covers that dental crown you need or medication you take every month.”
Medicare beneficiaries with a discontinued Medicare Advantage plan may need to:
- Enroll in a different Medicare Advantage plan.
- Enroll in a Part D prescription drug plan if they switch to Original Medicare.
- Enroll in a Medigap supplemental plan if they switch to Original Medicare. While Medigap is generally not available outside of your initial enrollment period – at least not without medical underwriting – people whose Medicare Advantage plans are being discontinued have guaranteed-issue access to certain Medigap plans.
Part D: New $2,000 annual cap on out-of-pocket prescription costs
Starting in 2025, consumers with Part D coverage – more than 80% of Medicare beneficiaries – will see their out-of-pocket costs for prescription drugs capped at $2,000 thanks to the Inflation Reduction Act of 2022. They also will be able to spread their out-of-pocket costs over a year under the new Medicare Prescription Payment Plan.
Possibly in response to these changes, some Part D insurers are reducing or discontinuing their offerings for 2025.
“If you were happy with your Part D plan this year, make sure it’s being continued and at a premium you can afford,” Chumbley Hogue said. “Check whether your medications are still covered, at which pharmacy and at what cost. You might find it necessary to enroll in a new Part D plan.”
Additional help for consumers
Consumers in need of assistance can contact 1-800-Medicare or their State Health Insurance Assistance Program (SHIP). SHIPs are not affiliated with insurance companies and can provide unbiased advice and assistance. Consumers can also reach out to a local agent or a broker for help.
Medicareresources.org has been an online source of in-depth information about Medicare for consumers since 2011. The site, owned by HealthInsurance.org, LLC, provides an overview of the basics of Medicare coverage options, enrollment and eligibility; coverage FAQs; state-specific Medicare information; and a glossary of Medicare terms. Medicareresources.org is not connected with or endorsed by the U.S. government or the federal Medicare program.
Contact:
Amy Fletcher Faircloth, [email protected]
Tags: enrollment, Medicare Advantage, Medicare Part D
