Major Medicare Changes Coming in 2025: What You Need to Know

Medicare and change go hand in hand, as anyone on Medicare can attest. What sets 2025 apart? Next year will bring the most significant updates to Medicare since 2005. These changes are outlined in a 1,400-plus-page report published by the Centers for Medicare & Medicaid Services (CMS).

While the report covers all upcoming modifications, I’ll focus on a few key changes that may directly affect Medicare beneficiaries. The biggest shift will occur in Medicare Part D, which covers prescription drugs.

For the first time, a maximum out-of-pocket limit of $2,000 will be introduced for prescription drug co-pays. Once someone on Medicare reaches $2,000 in prescription costs, they will no longer have to pay co-pays for the rest of the year. Additionally, the infamous “donut hole,” or coverage gap, will be permanently closed in 2025—a huge relief for those on high-cost medications.

Starting next year, beneficiaries on expensive prescriptions will also be able to spread their co-pays over 12 monthly payments. However, those on stand-alone Part D drug plans should expect increased monthly premiums.

For Medicare Advantage enrollees, a midyear notification will remind them of any unused supplemental benefits. Medicare Advantage plans will also need to review the impact of prior authorization policies on at-risk populations. Additionally, there will be improved access to mental health professionals.

Dual eligibles—those who have both Medicare and Medicaid—will lose the ability to switch plans every quarter, starting in 2025.

These are just some of the changes coming in 2025. Medicare beneficiaries should have received their Annual Notice of Change in September. Be sure to review it carefully to understand how your Medicare Advantage or stand-alone Part D plan will be affected.

If you have any questions or need help navigating Medicare changes during the Annual Enrollment Period, contact Mel Thornton, a local Medicare broker licensed in Georgia and Alabama, in partnership with The Miley Agency, a full-service insurance agency in Columbus. She can be reached at (706) 751-9800.

Major Medicare Changes Coming in 2025: What You Need to Know
Mel Thornton, Your Medicare Insurance Expert
Contact:
For a consultation: (706) 751-9800
4903 Armour Rd, Columbus, GA 31904
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