Along with Halloween and Thanksgiving, the Medicare Annual Enrollment Period is a rite of autumn for many Medicare-eligible beneficiaries. From October 15 through December 7, Medicare enrollees can add, drop, or switch coverage for plans such as Medicare Part D and Medicare Advantage.
In any year, it’s a good idea to review your Medicare coverage for changes in costs, benefits, and medical network coverage. The recent release of price and other plan details reveals some significant changes, particularly for 2025 Medicare Part D and Medicare Advantage plans and it may be useful to get help sorting out your options from sources like Medicare.gov, the State Health Insurance Assistance program, which has counselors in every state, and Fidelity Medicare Services®, which does business in every state plus the District of Columbia, although agents are not physically located in each state.
“Especially this year it might be worth taking the time to review your coverage with a Medicare expert,” says Harold Stankard, Head of Fidelity Medicare Services.
Here are some things that will change in 2025.
Changes to plan pricing
The Centers for Medicare & Medicaid Services (CMS) announced premium and deductible increases to Parts A and B for 2025. While the majority of Part A Medicare beneficiaries pay no premiums, their inpatient hospital deductibles will increase by 2.7% to $1,676 in 2025.1 The standard Part B premium will increase 5.9% to $185 per month in 2025, while the annual deductible will climb 7.1% to $257.2 CMS announced an increase in the base premium for Part D of about 6% to $36.78,3 and an increase of 8.3% in the annual deductible for Part D plans to $590 in 2025 from $545 in 2024.4
Important changes to Part D
Bigger changes triggered by existing provisions in the Inflation Reduction Act of 2022 are coming to Medicare. In addition to capping the base beneficiary premium to no more than 6% above the prior year's amount for Medicare Part D, the Inflation Reduction Act for the first time grants Medicare the ability to negotiate drug prices under Medicare Part D directly with the pharmaceutical companies. Medicare has already negotiated lower prices with pharmaceutical manufacturers for 10 high-cost, single-sourced drugs, but this policy will not be implemented until January 2026.
Other changes in Medicare Part D’s prescription drug coverage, however, take effect starting January 1, 2025. One of these is the elimination of the so-called donut hole, or coverage gap, which should simplify the sharing of costs between policyholders and insurance companies and potentially lower how much you pay for your prescription drugs in a given year.
Another important change that takes effect next year is the cap on out-of-pocket spending on drugs. This cap, which includes Part D deductible phase spending, copayments, and coinsurance, will be capped at just $2,000 (with no copay over $2,000) in 2025 and will be indexed for inflation in future years. Previously there was no fixed-dollar cap on out-of-pocket spending, although beneficiaries might qualify for catastrophic coverage for high out-of-pocket costs of $8,000 or more in 2024.
“This is one of the more meaningful changes in Medicare Part D coverage for some time,” says Brad Tyson, a licensed insurance agent at Fidelity.
Some policyholders will benefit from the new cap under the Inflation Reduction Act. For example, people eligible for Medicare who take many or have expensive drugs stand to gain since their out-of-pocket cost of covered drugs is limited to $2,000, which implies that Part D plans will need to pick up a greater share of the costs. But since the insurance and drug companies are (mostly) for-profit, private enterprises, they could alter their insurance strategies to compensate for the disappearance of the donut hole and the sharp cut in the out-of-pocket cap.
Insurance carriers may employ other techniques to cut costs such as reducing the number of drugs they cover for each medical condition and revising the tier structure for drugs to move some into a higher-priced tier. Some insurance companies will simply exit the market: Mutual of Omaha, for instance, this year announced that it is leaving the Medicare Prescription Drug Plan (PDP) market at the end of 2024.5
Broadly speaking, the bottom line is that Medicare-eligible beneficiaries who take expensive drugs are likely to benefit. “If you use a lot of prescription drugs, say $6,000 to $8,000, the new $2,000 cap is great,” says Ben Isgur, Vice President, Health Care Thought Leadership at Fidelity. But those who take few prescription drugs will likely pay a little more out of pocket due to premium increases.
Fidelity can help you explore Medicare Part D prescription drug plans for 2025.
A shifting landscape for Medicare Advantage
It’s important to be on the lookout for changes to Medicare Advantage plans, also known as Part C or “all-in-one” plans.
More than 50% of Medicare beneficiaries are now enrolled in Medicare Advantage (MA) plans,6 which include Parts A, B, and in some cases Part D in addition to benefits that might include dental, hearing, and vision. Under MA policies the government contracts with private insurers to provide benefits. Many plans offer prescription drug coverage that will be affected by the new $2,000 a year out-of-pocket limit, which applies to drug coverage in MA plans as well as for stand-alone Part D plans.
A key selling point is that most plans come with no premiums (though policyholders pay a premium for the plan’s Part B coverage, as well as any higher premiums for Parts B and D if they are high earners), so a dramatic increase in premiums seems unlikely in the near term. However, companies can adjust plans to increase deductibles, boost copays, raise the out-of-pocket spending limit for in-network and out-of-network health and hospital services, or trim benefits such as for dental plans included in MA policies.
Some insurers may attempt to cut costs by discontinuing some plans and exiting less-profitable markets altogether. For example, Humana is exiting 70 Medicare Advantage counties in 2025, (although it’s entering 12 new ones).7
Review your coverage with an expert
People enrolled in Medicare plans in 2024 should have received Annual Notice of Change letters in late September or early October that outline changes in coverage for 2025. Reviewing these letters is a good first step to determine how your plans could change in 2025. Since so much will be in flux in 2025 policies, it probably makes sense to sit down with a licensed insurance agent who specializes in Medicare during this fall’s Medicare Annual Enrollment Period to review your existing coverage and decide if you’d like to keep the same plan or switch to another.
“Every year it’s a good idea to review your financial plan and your health plan in retirement to confirm that the health plan meets your coverage preferences and health needs at the lowest cost possible,” Stankard says. In fact, there’s a large overlap between health costs and retirement financial planning: According to the 2024 Fidelity Retiree Health Care Cost Estimate, a 65-year-old person may need $165,000 in after-tax savings to meet health care expenses in retirement.8
As you prepare for a meeting with a licensed insurance agent who specializes in Medicare, here are some questions to keep in mind:
- Is my existing plan still appropriate for me?
- Does my Medicare Part D drug plan still meet my needs in 2025, or should I consider switching to another plan?
- Will I likely end up paying more or less for drugs (including for premiums) in 2025?
- What are the major changes for my Medicare Advantage plan in 2025 in terms of costs, benefits, and network coverage?
Fidelity offers Fidelity Medicare Services, with insurance agents licensed in every state who can review Medicare plans for customers living in any Zip code. As a complimentary service, these licensed insurance agents who specialize in Medicare can educate Medicare beneficiaries and help them enroll them in plans that might be right for their situations. There’s no need to be a Fidelity account holder to use the tools on the website or to arrange a meeting with a licensed insurance agent who specializes in Medicare who can help you map out a plan during the Medicare Annual Enrollment Period. You can also learn more about your options at Fidelity’s Medicare Annual Enrollment Period Learning Center.