For the millions of Americans enrolled in Medicare, it’s important to examine your coverage choices for the next year.

The annual Medicare enrollment period started on Tuesday and will continue until December 7. During this time, current enrollees have the opportunity to renew or alter their health insurance plans.

Medicare is the federal health program designed for individuals aged 65 and older, as well as younger individuals with disabilities or specific medical conditions. It’s estimated that more than 36 million older adults, representing slightly over half of this demographic, will opt for a private Medicare Advantage plan for 2025 instead of the traditional government-managed Medicare option.

Medicare Advantage involves insurance companies like UnitedHealthcare and Aetna partnering with Medicare to offer insurance plans that often include networks of healthcare providers and certain cost-sharing measures, such as copayments or deductibles.

The details regarding coverage and in-network providers for these private plans may differ from year to year. Therefore, both new and existing Medicare participants should review their plans carefully during this enrollment period, according to Tricia Neuman, a senior vice president at KFF, a nonprofit health policy organization.

As stated by Neuman, who oversees the KFF’s Medicare policy program, “Beneficiaries should dedicate time to examining their plan(s) and comparing choices to avoid any unexpected issues in the upcoming year.”

What Are the Costs for Private Medicare?

A recent Medicare fact sheet indicates that the average premium for a Medicare Advantage plan that includes drug coverage will be approximately $17 per month in 2025, a decrease from $18.23 monthly this year.

According to the fact sheet, around 83% of enrollees will have the same or lower premiums in 2025 as long as they remain with their current plans.

However, not all individuals will have the option to keep their current private Medicare plans. Mary Beth Donahue, president and CEO of Better Medicare Alliance, noted that fewer than 10% of consumers may need to look for new plans since their existing coverage will be discontinued. An analysis by ATI Advisory suggested that around 2 million seniors will have to find new Medicare plans either because their current plans will end or because they will no longer be available in their county. According to ATI, this represents about 7% of individuals enrolled in private Medicare plans.

What Changes Will Occur in My Plan in 2025?

Some Medicare plans are reducing additional benefits and raising deductibles, which could result in higher out-of-pocket expenses for some seniors. This reduction in coverage is largely due to lower reimbursement rates from Medicare, according to Donahue.

Donahue mentioned that private insurers are largely maintaining dental and vision coverage, which is not typically offered in traditional Medicare. Nonetheless, certain special needs plans are cutting back on benefits like transportation and meal services.

A KFF analysis published recently states that the average Medicare beneficiary will have access to 34 options for prescription drug plans in 2025, which is just two fewer than the 36 plans available in 2024.

What Changes Will Affect My Prescription Drug Coverage?

Good news awaits those needing medication for chronic conditions! Starting in 2025, consumers whose prescription drug expenses exceed Medicare’s catastrophic coverage threshold will benefit significantly.

Thanks to the Inflation Reduction Act signed by President Biden in 2022, out-of-pocket costs for prescription medications for Medicare users will be capped at $2,000 next year. This law also allows the federal government to negotiate prices for some of the most expensive drugs covered under Medicare.

Most private Medicare plans include prescription drug coverage. For those who opt for traditional Medicare while also enrolling in Part D for drugs, premiums are projected to decrease to $40 monthly, down from $41.63 per month in 2024, based on Medicare documents.

This month, a report from the nonpartisan Congressional Budget Office (CBO) predicted that changes in prescription drug benefits would result in higher federal expenditures than initially estimated. The CBO now forecasts that the 2022 federal legislation will increase federal spending by an additional $10 to $20 billion next year.

What Are the Differences Between Private Medicare and Traditional Medicare?

Individuals opting for private Medicare instead of traditional Medicare generally pay lower monthly premiums and receive extra benefits such as dental, vision, and gym memberships.

However, there are certain compromises when selecting these plans, as noted by Neuman from KFF.

While traditional Medicare allows participants to choose from a vast range of doctors and hospitals, private Medicare plans usually limit access to a smaller network of healthcare providers. Additionally, private Medicare plans often have cost-sharing requirements like deductibles and may require pre-authorization for certain tests or procedures.

Traditional Medicare requires patients to pay 20% coinsurance, which is the portion of a medical bill the beneficiary pays out-of-pocket. Medicare recipients can opt for MediGap, a supplemental insurance that covers these extra charges, which can accumulate after a medical procedure or hospital stay. Enrollment in MediGap is allowed under specific circumstances, such as turning 65 or when first enrolling in Medicare.

Need Assistance with Your Choices?

For essential information on enrollment and comparing Medicare plans, you can visit the Centers for Medicare and Medicaid Services website.

Additionally, you can reach out to your local health insurance assistance program to consult with experts who can provide guidance. These specialists offer free assistance to help you understand your options.

Join individual consultations where you can ask questions regarding medical services and prescription drug plans. This guide will assist you in locating advisors within your state.

Additionally, you can reach out to the nonprofit Medicare Rights Center for assistance with enrollment and benefits by calling their free national helpline at 800-333-4114.