Upcoming changes to Medicare in 2025
CMS is announcing significant changes to Medicare for the contract year 2025 to support and improve stability for people with Medicare in 2025. With the looming Medicare Open Enrollment Period, you will be able to make changes to your Medicare coverage if desired. Knowing about these changes will help you make an informed decision for the Medicare Open Enrollment Period. Here are some of the changes to Medicare coming up in 2025.
1. New $2,000 annual cap on out-of-pocket prescription costs for Part D holders
Beginning in 2025, people with Part D plans won’t have to pay more than $2,000 in out-of-pocket costs, thanks to a provision in the Inflation Reduction Act of 2022. The $2,000 cap will be indexed to the growth in per capita Part D costs, so it may rise each year after 2025.
If you are enrolled or looking to to enroll in Medicare Part D plans, review your choices carefully by using the Medicare Plan Finder. Comparing plans is the best way to ensure the prescription will be covered if there is a specific medication you take regularly.
This new rule applies only to medications covered by your Part D plan. The new annual cap does not apply to out-of-pocket spending on Medicare Part B drugs. Part B drugs include vaccinations, injections a doctor administers, and some outpatient prescription drugs. The $2,000 out-of-pocket spending cap applies to deductibles, copayments and coinsurance in the prescription drug portion of Medicare Advantage plans.
2. A new midyear notification to Medicare Advantage policyholders
Medicare Advantage plans offer coverage that traditional Medicare doesn’t. These benefits include dental, vision, hearing, fitness and even financial benefits. Every Medicare Advantage plan includes supplemental coverage, and some have extra coverage on traditional Medicare.
However, 3 in 10 beneficiaries of supplemental coverage said they didn’t use any of these benefits in the past year. Whether due to forgetfulness, a lack of need, or otherwise, 30% of people didn’t use their additional coverage at all. The midyear statement will now show available benefits that you haven’t used.
Beginning in 2025, Medicare Advantage plans will need to provide policyholders with a tailored “Mid-Year Enrollee Notification of Unused Supplemental Benefits” each July. This notice will detail any unused supplemental benefits, including the extent and cost of claiming each benefit, how to access them, and a customer service contact number for further assistance.
3. Changes to Medicare to add more mental health providers
The percentage of adults 65 and older reporting they used mental health services is only roughly 20%. However, this may be to some extent due to the level of access that Medicare holders have to mental health services.
Before this year, many of the mental health, counseling, and addiction recovery services were not considered Medicare services. Because of this, they were not allowed to bill Medicare. The cost of these services fell to the Medicare policyholder. This year, they can bill Medicare, and some already have started.
Medicare Advantage plans must meet stricter standards to improve access to behavioral health specialists. Similarly, Medicare is looking to permanently expand access to Telehealth services for behavior health services.
Take advantage of the changes to Medicare
With the changes to Medicare upcoming in 2025, it can mean a lot of good things for many people. Get a Medicare plan tailored to your health needs to take the most advantage of these changes. Cheaper out-of-pocket maximums for Part D, and more incentive to use your supplemental coverage mean more benefits out of your plan. Medicare Advantage is more advantageous than ever, so don’t wait on securing your health.
