The enrollment period for Medicare plans is now open, and the most important task for seniors and those who qualify is to evaluate their coverage, check their options, and plan their health care for 2025.
Those eligible for this federal health insurance program are Americans over age 65, as well as younger people with disabilities or serious illnesses. These are some of the most vulnerable segments of the population and the ones who need the most help when it comes to health care, so properly weighing their options is the best thing they can do for their health.
How do Medicare beneficiaries use Medicare?
- Part A helps cover hospital care, skilled nursing facility care, hospice care, and home health care.
- Part B helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (such as wheelchairs, walkers, hospital beds, and other equipment), and many preventive services (such as screenings, shots or vaccinations, and annual “wellness” visits).
- Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines). You can join a Medicare drug plan in addition to Original Medicare, or you can get it by joining a Medicare Advantage plan with drug coverage.
- Part C, better known as Medicare Advantage, is a plan approved by a private company that offers an alternative to Original Medicare Parts A and B for your medical and drug coverage. These “bundled” plans include Part A, Part B and, usually, Part D.
How will the Part D changes affect insurers and beneficiaries?
Part D has undergone some changes to avoid substantial premium increases in 2025, such as limiting insured prescription drug costs to $2,000 annually, but these changes have made it difficult for the private sector to assess the price of the service it will provide and, as a result, for the first time since 2006, the enrollment period has begun without a clear price list for Medicare Part D.
But some seniors face an even bigger problem. Some insurance companies have decided that the Medicare changes are too costly for them and opted to exit certain markets or significantly reduce their presence.
This has left many beneficiaries with no options for Part C or D and only public options for Medicare coverage, which generally do not cover things like dental or vision care.
This has made the remaining insurers more likely to raise costs, not only to cover expenses, but because of the lack of other options in the marketplace, which in turn has caused the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers the Medicare, Medicaid and Children’s Health Insurance Programs, to cap increases at $35 per year.
This means that, in 2025, the Part D base premium will likely increase to $36.78, which is $2.08 more than in 2024, an increase of up to 6%.
While this increase seems small, it may still put additional pressure on seniors and people with disabilities who often rely on fixed incomes.