Medicare Advantage BIG Changes in 2025

Major Changes to Medicare Advantage Plans in 2025

Negative Changes

Some of the changes to Medicare Advantage plans in 2025 may impact your current coverage negatively. Here are the two biggest concerns:

1. Plan Terminations
   • Several Medicare Advantage plans available in 2024 will no longer be offered in 2025. This varies by county, so whether you’re affected depends on where you live. Some areas might see minimal changes, while others could experience significant disruptions.
2. Reduced Benefits
   • Extras like dental, vision, and hearing benefits may be reduced or eliminated. Additionally, costs such as co-pays, out-of-pocket maximums, and deductibles are increasing for some plans. These changes could result in higher out-of-pocket expenses for beneficiaries.

Positive Changes

Thankfully, there’s some good news on the horizon, particularly regarding prescription drug coverage:

1. Out-of-Pocket Prescription Drug Cap
   • Starting in 2025, the maximum out-of-pocket cost for prescription drugs will be capped at $2,000. This includes co-pays and deductibles but not your plan’s premium. This change is a significant improvement for individuals on expensive medications.
2. Elimination of the Donut Hole
   • The dreaded “donut hole” is going away. Instead of the previous coverage stages, you’ll now experience:
     • Deductible Stage
     • Initial Coverage Stage
     • Catastrophic Coverage Stage
   • Once you meet the $2,000 maximum out-of-pocket cost, you’ll pay nothing for prescription drugs for the rest of the year. In previous years, the out-of-pocket limit was higher, making this a big win for many beneficiaries.
3. Spread Out Drug Costs
   • You’ll now have the option to spread your prescription drug costs throughout the year. Instead of facing high expenses in the first few months, the total cost will be divided over 12 months. You’ll receive a monthly bill from your insurance provider, making it easier to budget for your medications.

What to Do If Your Plan Is Leaving or Benefits Are Reduced

If Your Plan Is Terminating

If your Medicare Advantage plan is being discontinued in 2025, you have two main options:

1. Switch to a New Medicare Advantage Plan
   • This is the most straightforward choice. You’ll need to find a new plan that includes your doctors and covers your medications. We can help you explore the options available in your area.
2. Use Your Guarantee Issue Right for a Medicare Supplement Plan
   • If your plan is terminated, you qualify for a guaranteed issue right to switch to a Medicare Supplement (Medigap) plan. This means you won’t need to answer any health questions.
     • Plan F: Available if you became eligible for Medicare before January 1, 2020.
     • Plan G: Available if you became eligible after January 1, 2020.
   • Note that guaranteed issue rights apply only if your Medicare Advantage plan is terminated.

If Your Plan’s Benefits Are Reduced

If your current plan is still available but with reduced benefits, here are your options:

1. Switch to a Better Medicare Advantage Plan
   • We can help you find a new plan that offers better coverage and fits your needs. Contact us to review your options.
2. Underwrite Into a Medicare Supplement Plan
   • Since your plan is not being terminated, you’ll need to go through health underwriting to qualify for a Medigap plan. This involves answering some basic health questions. If approved, you can enjoy the comprehensive coverage of a Medigap plan.

Key Enrollment Periods for 2025

• Annual Enrollment Period (AEP): October 15 to December 7, 2024.
  • During this time, you can switch to a new Medicare Advantage plan or change your Part D prescription drug plan.
• Special Enrollment Period (SEP): December 8, 2024, to February 28, 2025.
  • This applies if your Medicare Advantage plan is terminating. You’ll have additional time to choose a new plan.

How to Change Your Plan

1. Find a Suitable Plan
   • Look for a plan that includes your doctors and medications, and meets your financial needs. Check out my video on choosing the best Medicare Advantage plan for more tips.
2. Submit an Application
   • Once you’ve selected a plan, complete the application process. Your new coverage will take effect on January 1, 2025.
3. Switching from Medicare Advantage to Medigap
   • If using your guarantee issue right, submit proof that your Medicare Advantage plan is terminating along with your Medigap application. If underwriting is required, answer the health questions and await approval.
4. Prescription Drug Plan
   • Most people transitioning to a Medigap plan will also need a standalone Part D drug plan. Enrolling in a Part D plan automatically cancels your old Medicare Advantage plan, simplifying the transition.

Get Expert Help Today

Navigating these changes can be overwhelming, but you don’t have to do it alone. At Bluewave Insurance, we’re here to help you explore your options and secure the best plan for your needs in 2025. Give us a call at 800-208-4974, and let’s get started!

Thanks for reading, and don’t forget to like and subscribe to stay updated on all things Medicare. See you next time!