It’s always important for people to compare plans during Medicare open enrollment from Oct. 15 to Dec. 7, but it’s even more critical this year. There are changes coming to Medicare Advantage plans and Medicare Part D prescription drug plans, and you should make sure you understand how your plan will cover you — or not — in 2025.
“People think they don’t need to review their plans every year, and that couldn’t be further from the truth,” says Kari Vogt, a certified financial planner and licensed insurance agent in Columbia, Missouri. “You might not change your plan every year, but you should always review your plan.”
But only about half (54%) of Medicare Advantage members look through their plan’s coverage information to see what’s changing for the coming year, according to a 2022 survey from health policy nonprofit KFF.
Here are three reasons you should spend some time with your Medicare paperwork this fall.
There’s a new Part D cap
Starting in 2025, Medicare Part D prescription drug plans are capping consumers’ out-of-pocket spending at $2,000 — a big change from previous years. Sounds great, right? But take note: This is only true for drugs covered by your plan, and plans can change their coverage each year.
“It’s possible that Part D plan sponsors may make changes to the Part D plan in terms of the list of covered drugs — also called the formulary — and cost-sharing tiers the drugs are on,” says Meredith Freed, a senior policy manager with the KFF Program on Medicare Policy. Additionally, premiums may increase, particularly for stand-alone Part D plans.
This also affects Medicare Advantage plans that include prescription drug coverage, so everyone needs to check the terms when plans send their Annual Notice of Change this fall.
“That document is typically a little short of 30 pages,” says Melinda Caughill, co-founder and CEO of 65 Incorporated, which offers Medicare guidance. “It will have links to the formulary list, so take a look at that document. Don’t just throw it out.”
Once you’ve scoured your plan’s 2025 updates, visit Medicare.gov and enter your prescription drugs (with exact dosage) into the plan finder to see what else is available, either for Medicare Advantage or Part D. Find the total out-of-pocket cost on each plan, and keep in mind that if a drug isn’t covered, you’ll pay the full amount out of pocket.
If one of your pricier drugs won’t be covered next year, you may need to call your doctor to see if there’s something else you could take. “You could have a $0-premium drug plan but pay $20,000 a year because your medications aren’t covered,” Caughill says.
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Medicare Advantage is an alternative to traditional Medicare offered by private health insurers. It covers the same benefits as Medicare Part A and Part B.
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Medicare Advantage providers may be reducing benefits
There have been reports that some Medicare Advantage companies will shrink benefits in 2025 due to financial headwinds. This could occur in a few ways. “Maybe the cost sharing will increase for certain services, [or] maybe the plan is less comprehensive in terms of benefits it covers,” Freed says.
If the extra benefits are important to you, take a good look at the plan documents and see what’s changing in 2025, and whether there are other plans that might be a better fit for your situation.
If you have questions about what your plan covers in 2025, get help by calling 800-MEDICARE (800-633-4227, TTY 877-486-2048) or through your State Health Insurance Assistance Program, or SHIP. “You can actually talk through it with someone and make sure you understand the changes to your plan — and potentially if you really want to stay in a certain plan,” Freed says.
Medicare Advantage providers are dropping plans
Some Medicare Advantage companies have announced they’re discontinuing some plans in 2025 — or even, in some cases, dropping entire states from their offerings. If your provider is discontinuing your plan in 2025, you have two options: Switch to another Medicare Advantage plan in your area or return to Original Medicare. (If you do nothing at all, you’ll be returned to Original Medicare by default.)
If you choose to go back to Original Medicare because your plan is ending, you get another chance to join a Medicare Supplement Insurance plan, also known as Medigap, without any medical underwriting. Ordinarily, this is only possible during Medigap open enrollment, which is the six month period that starts the month you’re at least 65 and enrolled in Medicare Part B.
“When you are dropped from a plan based upon no action of your own, such as the plan going out of business, you have a Medicare do-over,” Caughill says.
Whatever you do, don’t simply let your coverage renew without looking at it closely. “This is work,” Caughill says. “You’ve got to put the time in. You are agreeing to the changes of [your provider’s] terms, and you need to know what these terms are.”
