3 important changes for 2025

According to Forbes, by 2025 there will be an average of 34 Medicare Advantage plans in every county in the United States, down from 43 this year.

Additionally, there will be 6.6% fewer Medicare Advantage plans with prescription drug coverage available next year compared to this year. This includes 5.4% fewer UnitedHealth Group plans and 2.5% fewer Humana plans.

Additionally, benefit options remain stable, CMS said, including complementary Medicare Advantage benefit offerings such as hearing, dental and vision benefits.

However, “many [Medicare Advantage] Plans … are adjusting their core benefits or reducing or eliminating additional benefits such as gym memberships,” said Whitney Stidom, VP of Medicare Operations at eHealth Insurance.

Robert Griffith, senior director at LA Care Health Plan, said his group is closely monitoring regulatory changes by CMS, including those “that emphasize health equity and encourage Medicare Advantage plans to provide benefits and outreach tailored to vulnerable populations.” -measures to be included”.

“These changes, combined with continued competition among Medicare Advantage plans in LA County, mean beneficiaries will likely see a broader range of plan options with expanded additional benefits,” he told Healthline.

Even if your Medicare Advantage plan is still available in 2025, your healthcare provider may no longer accept or participate in the plan.

Essentia Health, for example, announced that it would no longer accept Medicare Advantage plans from Humana and UnitedHealthcare. Sanford Health, a large medical provider in the Midwest, said it has terminated its contract with Humana Medicare Advantage.

In a recent HFMA survey, about 16% of health systems expect to stop accepting one or more Medicare Advantage plans in the next two years. They point to burdensome approval requirements and a high rejection rate for these plans.

If you have a Medicare Advantage plan, your medical care will only be fully covered if the provider is in the plan’s network. You cover all or most of the cost of out-of-network care.

With open enrollment, make sure your doctors, hospitals and other providers are on your 2025 plan list.

Stidom said it’s also important to read your Medicare insurer’s annual change letter and consider your options for 2025. Only three in 10 participants have reviewed their change letter, a recent eHealth survey found.

“This year, it is more important than ever for beneficiaries to review their plan’s annual change letter and ensure that the benefits their plan provides meet their needs,” she told Healthline.

Forbes also reports that in 2025, Medicare Advantage plans will be able to deny coverage for procedures and services recommended by your doctor. In this case, you must either stop treatment or appeal the decision.

According to CMS, there will be approximately 25% fewer Medicare Part D policies available in 2025. This is the lowest number of policies offered since Part D coverage began.

According to Forbes, many of the plans still offered in 2025 will have higher premiums, deductibles and other out-of-pocket costs. There may also be fewer medications covered by a plan or medications being moved to a different tier, which may affect the cost you pay for them.

If you take medication regularly or expect to do so in 2025, learn the details of your insurance options during open enrollment.

Griffith emphasized that “out-of-pocket costs for Part D will be capped at $2,000.” [annually]as part of the ongoing effort to close the “doughnut hole” or Part D coverage gap.” This change is due to the Inflation Reduction Act.

“Perhaps one of the biggest fundamental changes to Medicare Advantage is the new Medicare Prescription Payment Plan, designed to help the most vulnerable enrollees reduce their monthly expenses and improve the affordability of prescription drugs,” he said.

This allows participants to pay prescription drug costs in monthly installments rather than all at once when they pick up their prescriptions. All Part D plans must offer this option, but participant participation is voluntary.

Medicare open enrollment in 2025 will bring several important changes that may affect your insurance coverage. One major change is that the number of Medicare Advantage plans will decrease. However, the average monthly premium for Medicare Advantage plans will decrease to $17.00 in 2025 from $18.23 in 2024.

Some healthcare providers no longer accept or participate in certain Medicare Advantage plans. Medical care is only fully covered if a doctor, hospital or other provider is in your plan’s network. So check your 2025 plan list to make sure your providers are included.

In addition to a decline in the number of Medicare Part D prescription drug plans in 2025, many of the plans will have higher out-of-pocket costs, including premiums and deductibles. A plan may also cover fewer medications or move certain medications to a higher price tier.