By Kim Reyes, Benefits Counselor,SC Appalachian Council of Governments
Usually the saying, “Don’t fix it if it ain’t broke” is good advice to follow. However, with Medicare’s open enrollment period for 2025 which is October 15 – December 7th, you may not want to stay on auto pilot this year.
This is the time of year where you research your Part D and Advantage plan options for the upcoming benefit year beginning January 1. CMS [Centers for Medicare & Medicaid Services] allows contracting revisions by the Insurance companies annually, and beginning 2025 there will be significant changes to the structure of all available Part D and Advantage plans. Plans are allowed to change formularies, prescription tiers, deductibles, copays and premiums, so doing your homework is crucial to finding your very best coverage options for the new calendar year.
You wouldn’t want to find yourself in sticker shock when January 2025 rolls around and you get an unexpected increased premium notice or when you go the pharmacy to pick up your medications and the pricing is significantly increased. Better yet, since plans are allowed to change formularies, you want to make sure your current prescriptions are still on your plan’s formulary. If a plan’s formulary drops your medication, then you will be paying cash pricing for that medication.
One notable change with prescription coverage is the elimination of the “coverage gap or donut hole.” This sounds like a good thing; it is key to know how your prescriptions are going to be priced. In 2025 also, beneficiaries out of pocket pharmacy spending will be capped at $2000. This is certainly cause for speculation. Since the Inflation Reduction Act is ending the coverage gap and out of pocket pharmacy spending will be capped at $2,000, it makes one wonder, what will I be losing if CMS says all of these improvements will be occurring.
Part D deductibles can be as much as $590 in 2025, $545 for 2024, so for sure the deductible may be $45 higher next year depending on which plan you use. CMS is allowing beneficiaries to pay this deductible on a payment plan throughout the year instead of at the beginning of the year.
Final details on which plans will participate in the payment program for deductibles will be released October 1. Pay close attention to your ANOC (Annual Notice of Change). Plans are required to send the ANOC to their members in late September to give you a summary of changes in costs and coverage beginning January 1. Reviewing this document should assist you in identifying if your current plan will still suit your needs for the new year.
Many other changes will be in place also for those who receive “Extra Help” with part D and also those who participate in Part B premium assistance and Medicaid with your state. Enrollment periods have changed for those low income beneficiaries. In 2024, low income beneficiaries were allowed to change their plans quarterly. In 2025 that changes to monthly; certain circumstances will apply.
Don’t let Medicare Open Enrollment Oct 15 through Dec 7 pass you by this year. If you need help navigating your 2025 Medicare options, you can call 1-800-633-4227 for Medicare, or call your local SHIP [State Health Insurance Assistance Program] office at 1-864-242-9733 which provides unbiased plan counseling. Additionally, SC SHIP can assist with counseling options, fraud, claims and subsidy applications.
