You’ve probably heard or read that Medicare Open Enrollment season is upon us. People who have Original Medicare plans, Medicare Advantage Plans and Medicare drug plans will be able to make changes to their plans from October 15 until December 7 for coverage in 2025. From January 1- March 31, 2025, people already enrolled in Medicare Advantage plans will be able to change their current plan or switch to Original Medicare. You can learn when to enroll in a Medicare plan or change plans here.

As a refresher, Medicare part A covers hospitalization, Part B covers medical services and outpatient care and treatments, and Part D covers prescription drugs. Medicare Part C plans, also known as Advantage plans, provide comprehensive coverage, combining Parts A, B, and often Part D into a single plan. Information about the Original Medicare and Advantage plans available in your state is available on Medicare.gov.

The Inflation Reduction Act of 2022 included legislation that made important changes to Medicare law. In 2023, this legislation began phasing in with the elimination of copayments for vaccines and a cap of $35 per month on insulin products. This year, the Extra Help Program that assists low-income people with healthcare costs was expanded, and the 5% cost sharing (coinsurance) for prescription drugs in the catastrophic coverage phase was eliminated. This was a significant cost savings for people who are more likely to meet their out-of-pocket drug spending because they take expensive, specialty medications. In 2025, the annual out-of-pocket limit on prescription drug spending will decrease substantially, down from $8,000 in 2024 to $2,000 in 2025, and the new Medicare Prescription Payment Plan will allow beneficiaries to opt in to a program that will spread their annual out-of-pocket costs out over 12 monthly payments. In 2026, government-negotiated prices will be phased in for 10 drugs, with new drugs added each subsequent year.

These changes are a major step toward lowering healthcare costs for Medicare enrollees. Because changes behind the scenes to Medicare cost-sharing shift more of the burden from the federal government to private industry next year, there has been uncertainty about how this may impact the costs and coverages in Medicare plans. To ensure stability as these changes are implemented, the federal government allocated funding from a Medicare trust fund that is likely to reduce the average plan premium (the monthly cost for an insurance plan) for 2025.

Despite this assurance, it is more important than ever to review the changes to your plan for the coming year before you renew. Though your premium may be the same or lower, it’s very likely there will be changes to your plan’s coverages. You may have already received information from Medicare that provides a summary of these changes. Be sure to review this information carefully and look for changes in the following areas.

• Your annual out-of-pocket limit and copayments for covered services like office visits, emergency care, diagnostic testing, rehabilitation services, and hospitalization.
• Hearing, vision, dental, and mental health benefits.
• Your plan’s provider and pharmacy networks.
• Prescription drug copayments, deductible, and the tiers that determine how your medications are covered.
• Your plan’s drug formulary (covered drug list). Make sure every medication you take and those you think you may be prescribed next year are on the list. The $2000 annual out-of-pocket limit for prescriptions will only apply to medications on your plan’s formulary.
  
• The services you regularly use or rely on. If you are concerned about coverage for specific service or benefit, that’s a good indication you should look closely at how it will be covered by your plan next year.
  

If this is overwhelming, you’re not alone. You can reach out to your State Health Insurance Assistance Program (SHIP). SHIPs are a national program of the Administration for Community Living (ACL) that offer assistance, counseling, and education to Medicare beneficiaries so they can make informed decisions about their coverage and benefits. A SHIP navigator can provide one-on-one assistance with reviewing health or prescription drug plan options. They can answer questions about Medicare eligibility and coverage and provide information about financial assistance programs that are available in your state. To find the SHIP for your state, click this link to the national SHIP website, then click the orange "Find Local Medicare Help" or "SHIP Locator" button on the homepage.

Don’t assume your current Medicare plan will provide the same coverage next year. Review before you renew! If your current plan no longer offers the coverage you need, get help from your state’s SHIP, an informed family member or friend, or a private insurance counselor so you can choose a Medicare plan that works for you.