For those who will receive Medicare benefits for 2025 the time has come to prepare and start evaluating the options available to them. The program’s open enrollment is underway (it started in October and will run through December 7th) and beneficiaries have very little time to get up to date in the changes that have been made to the program, the options available to them and the impact they will have on their coverage for next year.

Medicare changes and options for 2025

One of the most important changes Medicare has implemented for the 2025 season is the cap on out-of-pocket prescription drug. Previously a donut hole existed, in which there was coverage until an amount, then prescriptions were paid out of pocket until a limit, after which it was covered again by the insurance company. This cap, set at $2,000 for the first time will help beneficiaries with health problems manage their expenses better and get better drug coverage as they will not be as worried about the expenses past a certain amount.

Another change is that now beneficiaries can choose to pay per month in installments for their prescriptions instead of having to do it all at once at the pharmacy. This would allow them to better plan for their expenses and have more disposal income throughout the year instead of always playing catch up.

Regrettably all of the benefits that these proposals could have brought are being undone by the insurance companies that make up the affected parts of Medicare, Part D and Medicare Advantage, or Part C. These companies have declared the new measures not to be profitable enough for them, especially in certain areas and have begun the process of exiting certain markets so as to not lose money on their plans.

For those who have not exited the market, they have revised some of the available plans and restricted whet seniors can purchase, have limited their offers, increased their deductibles and premiums or co-payments. This has in effect all but erased all the savings that could have been had by the new changes.

Ryan Ramsey, associate director of health coverage and benefits at the National Council on Aging advised seniors on how to proceed with avoiding the worst of the pitfalls caused by the changes “My best recommendation is start early, get your comparison nice and early. That way you can take your time with looking at that.”

Most seniors will just need to accept that they will have to change plans altogether or just be stuck with traditional Medicare options (Part A and Part B), which do not offer some of the Medicare Advantage options they have grown accustomed to, like vision or dental.

Tricia Neuman, Executive Director for the Program on Medicare Policy at KFF counsels “They have to reassess their options for the coming year. Checking to be sure that their doctors and hospitals are still in network, checking to be sure that the drugs they take are still covered. Unfortunately, the burden is on seniors to check to be sure that the plan that they’re in hasn’t made changes that will make it harder for them to pay for the drugs that they need.”

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Now the burden is squarely put on seniors and Medicare advisors to look into the programs, compare between them and figure out if the beneficiary qualifies for assistance programs or free discount prescription programs like GoodRx. The situation right now seems more dire than it is, as Medicare services will be available to seniors as long as the program has funds, the only difference is that mor thought will have to go towards figuring out where to get care.

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