It’s Baaack! Medicare Enrollment opens on October 15th

Yes, it’s time again for the Medicare Annual Enrollment Period, October 15- December 7 each year. My mind is now saturated with mailings and TV commercials from Baby Boomers making pitches, especially for Advantage plans. Eventually, I’ll just tune them out…. “Too much mindless information”. Oh, as a senior over age 65, I’ll also be mailed the Medicare and You 128-page handbook that looks like a phone book.

I wonder, “Do I really need to do anything? Mine’s not broke, why fix it?”

Since I am already enrolled in a Medicare Supplement plan or Advantage plan, I can certainly just keep my same plan without doing anything, and that’s okay.

However, even if I take no action or switch my plan, changes are coming for 2025, especially for prescription drug coverage

I expect to receive the required Annual Notice of Change for 2025 in September. This is my current plan’s notice of what changes are being made to my existing Supplement or Advantage plan.  I usually read these very carefully. Sometimes, I’m pleasantly surprised at expanded benefits or lower copays. Other times may be different with higher copays or deductibles.

For 2025, we can expect significant changes in our prescription drug plans. These are usually part of Advantage plans or enrolled separately as Part D prescription supplemental plans.

There are several important changes to Medicare Part D prescription drug coverage in 2025, including:

·       Elimination of the coverage gap: Also known as the “donut hole”, the coverage gap was a temporary limit on what drug plans will cover for drug costs. In 2025, Medicare will eliminate this gap. This has been phasing out for many years, but it’s finally gone.

·       Out-of-pocket spending cap: In 2025, Part D plans will cap out-of-pocket spending on covered drugs at $2,000 per year. This means that once a beneficiary has paid their deductible and reached the out-of-pocket maximum, Medicare and their drug plan will cover 100% of their Medicare Part D charges. This can help keep a lid on Rx costs.

·       Three-phase benefit structure: In 2025, Part D coverage will have three phases: a deductible phase, an initial coverage phase, and a catastrophic phase.

·       New Rx payment plan: A new Medicare prescription payment plan will be introduced to help spread out prescription costs throughout the year. This will be helpful with monthly budgeting and smoothing out the “lumps” that may occur when refilling prescriptions.

Other significant changes to Medicare include:

·       Medicare Advantage plans will be required to send midyear coverage notices. This is new and will list all supplemental benefits that have not been used, the scope and out-of-pocket cost for claiming each one, instructions on how to access the benefits, and a customer service number to call for more information.

·       Stricter marketing rules that hope to end sales incentives in 2025 for Medicare Advantage and Part D plans.

·       Medicare will cover additional caregiver support, like training that helps your caregiver better care for you and relief when they’re caring for family members in hospice care. Also, some people living with dementia and their caregivers may be able to get more support through a new pilot program.

·       Medicare will provide access to more mental health providers. Medicare covers expanded mental health care, like intensive outpatient program services in certain locations and services from marriage and family therapists and mental health counselors. During your yearly “Wellness” visit, your healthcare provider can also use a health risk assessment to better understand your social needs and refer you for appropriate services and support.

The bottom line here is that you and I may see significant changes in premiums, co-pays, and covered drugs for Part D prescription plans.

We at Grandview recommend comparing your current plan with other offerings. The best way to do this is to use the https://www.medicare.gov website (not .com). You can see side-by-side comparisons and even personalize with your exact prescriptions. Please do not focus only on premium costs.  While low premiums (or even zero premiums) are attractive, they might come with high deductibles or limited coverage. Consider the overall cost of the plan and how well it covers your needs.  If you find the options overwhelming, consider speaking with a Medicare broker or advisor. They can provide personalized advice and help you navigate the complexities of plan choices. Or, you may prefer to call Medicare directly at 1-800-MEDICARE (1-800-633-4227).