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Medicare open enrollment 2025 is scheduled to begin on Tuesday.
Beneficiaries will have between Oct. 15 and Dec. 7 to evaluate their Medicare coverage options and choose a new plan for next year.
Experts say this is an important opportunity for retirees that should not be ignored.
But only 30% of Medicare enrollees review their options each year, according to a study by KFF, a provider of health policy research.
“People’s needs change from year to year and plans change, so it makes sense to compare coverage options every year,” said Tricia Newman, executive director of KFF’s Medicare Policy Program. Ta.
“When you make these comparisons, there can be significant differences in coverage and cost,” she said.
The new year brings new changes to Medicare, so beneficiaries may need to do careful research during this recruitment period.
“My best advice is to start early,” said Ryan Ramsey, deputy director of health insurance and benefits for the National Council on Aging.
Changes that can be made during open enrollment
During Medicare Open Enrollment, retirees can choose new health and prescription drug plans.
You can switch from Original Medicare, which is provided by the federal government, to a privately managed Medicare Advantage plan. You can also switch from Medicare Advantage to Original Medicare or change your Medicare Advantage plan.
Original Medicare includes Medicare Parts A and B. Medicare Part A includes care provided by hospitals, skilled nursing facilities, hospices, and some home health care. Medicare Part B includes physician services, outpatient care, medical supplies, and preventive services.
Original Medicare beneficiaries can choose to sign up for a Medicare Part D plan to add prescription drug coverage or add additional coverage for out-of-pocket costs through Medicare Supplemental Insurance or Medigap.
Alternatively, beneficiaries may choose a private Medicare Advantage plan that offers Medicare Parts A and B and may also include vision, dental, hearing, and prescription drug coverage.
Changes in 2025 that may impact coverage
In 2025, the $2,000 out-of-pocket cap for Medicare Part D goes into effect.
The change, which is part of the Inflation Control Act of 2022, is “great news” for retirees who have expensive prescription drugs they need to take, according to Get What’s Yours for Medicare: Maximize Your Coverage, said Philip Moller, author of “Minimize Your Covers.” It costs money. ”
However, Mueller explained that insurers may seek to pass on the high Medicare Part D and other prescription coverage costs they currently face due to these changes. That could come in the form of higher prescription copays, more expensive coverage for certain drugs, or complete elimination of coverage for some drugs.
“This means consumers need to be very careful about open registration,” Moller said.
Notably, the Biden-Harris administration will increase the amount of allowable increases in Part D premiums. $35/month In 2025, KFF’s Newman said.
Mueller said retirees should also be aware of changes to their Medicare Advantage coverage.
In some cases, private insurance companies may discontinue your plan or move you out of a geographic area that is no longer attractive to your business. Retirees may be more likely to seek Medicare Advantage plans for prescription drug coverage, but recognize that changes may be made that affect the total costs those plans will pay. Moller explained that it is necessary to do so.
Newman said people who have Medicare Advantage and want to switch to Original Medicare should be aware that they may not be able to get Medigap insurance if they have a pre-existing condition.
Notably, four states have safeguards in place to prevent that: Connecticut, Maine, Massachusetts, and New York.
“In other states, if you have a serious medical condition, even asthma, diabetes or other conditions, it may be more difficult to opt out of a Medicare Advantage plan and find Medigap insurance.” said Newman.
The best way to shop
Experts say thorough research is the best way to estimate the costs retirees may face in switching their current plan or coverage.
Individuals can use Medicare.gov to compare plans or contact Medicare by calling 1-800-MEDICARE.
Ramsey said the State Health Insurance Assistance Program (SHIP) program is also available in all states and provides in-depth, unbiased counseling free of charge.
Start now if you can, Ramsey said.
That extra time will give you plenty of time to gather your Medicare.gov login information, prescription drug list, review plan comparison information and ask additional questions, he said. said.
Importantly, there’s no need to rush into changing your coverage, Moller says, and you should take plenty of time to consider your coverage options.
“There’s no need to rush to judgment,” Mueller said. “Even if you wait until Dec. 7 to elect coverage for 2025, it will go into effect on Jan. 1 of next year.”
