If you’re one of the millions of Americans enrolled in Medicare, it’s time to take a close look at your coverage options for the upcoming year.

The annual Medicare enrollment period has started as of Tuesday and will continue until December 7. This is your opportunity to renew or alter your health insurance coverage during these weeks.

Medicare is the federal health program designed for individuals aged 65 and over, as well as younger people with disabilities or other qualifying health issues. For 2025, slightly more than half of older adults, nearly 36 million, are anticipated to select a private Medicare Advantage plan over the traditional Medicare program run by the government.

With Medicare Advantage, insurance companies like UnitedHealthcare and Aetna partner with Medicare to offer insurance plans, which usually involve medical provider networks and require some cost-sharing, such as copayment and deductibles.

Since the conditions and in-network providers for private plans can change from year to year, both new and existing Medicare enrollees should carefully review their plans during this enrollment period, advises Tricia Neuman, a senior vice president at KFF, a nonprofit focused on health policy.

Neuman, who oversees the KFF program addressing Medicare policy, stated, “Beneficiaries should invest the time to review their plan(s) and compare options to avoid any unpleasant surprises in the coming year.”

What are the Costs for Private Medicare?

A Medicare fact sheet indicates that the average monthly premium for a Medicare Advantage plan that includes prescription drug coverage will drop to roughly $17 in 2025, compared to $18.23 this year.

It is projected that about 83% of enrollees will either keep the same or see a decrease in their premiums in 2025 if they continue with their current plan, as per the Medicare information.

However, not all individuals will have the opportunity to keep their current private Medicare plans, as stated by Mary Beth Donahue, the president and CEO of Better Medicare Alliance, representing private Medicare providers.

Fewer than 10% of consumers will need to seek out new plans because their existing coverage plans are being discontinued. An analysis from the research firm ATI Advisory estimates that approximately 2 million seniors will either have their Medicare plan end in 2025 or no longer be available in their local area. According to ATI’s estimates, around 7% of private Medicare plan participants will need to find a new option.

What Changes Can I Expect for My Plan in 2025?

Some Medicare plans are reducing additional benefits and raising deductibles, which may result in higher out-of-pocket costs for some seniors. Donahue notes that private insurers are cutting back on coverage or altering their offerings due to lower Medicare reimbursement rates.

However, Donahue mentions that the vast majority of private insurers are maintaining dental and vision benefits, which traditional government-run Medicare does not include. Nonetheless, certain special needs plans are reducing benefits that cover transportation and meals.

According to a KFF analysis released on Tuesday, the average Medicare beneficiary will have 34 different options for prescription drug plans in 2025, which is just two fewer than the 36 plans available in 2024.

What Will Change with My Prescription Drug Coverage?

There is positive news for those who take medication for ongoing health issues. In 2025, consumers whose drug costs surpass Medicare’s catastrophic coverage threshold will receive significant relief.

The Inflation Reduction Act of 2022, enacted by President Joe Biden, will limit out-of-pocket prescription drug expenses for Medicare recipients to $2,000 next year. The legislation also empowers the federal government to negotiate prices for some of the most expensive medications covered by Medicare.

Most private Medicare plans include some form of prescription drug coverage. For those who opt for traditional Medicare and add Part D for drug coverage, premiums are expected to decrease to $40 a month, down from $41.63 in 2024, according to Medicare updates.

A recent report from the nonpartisan Congressional Budget Office indicates that changes to prescription drug benefits will lead to higher federal spending than initially projected. The CBO now anticipates that the 2022 federal legislation will increase expenditures by an additional $10 to $20 billion next year.

What Sets Private Medicare Apart from Traditional Medicare?

When individuals choose private Medicare plans instead of traditional Medicare, they often benefit from lower monthly premiums and added perks such as dental and vision coverage, as well as fitness memberships.

However, Neuman highlights that there are trade-offs to these plans.

While traditional Medicare allows participants to select from a broad range of healthcare providers and facilities, private Medicare plans typically limit access to a narrower selection of networks, which includes hospitals, doctors, and laboratories. Moreover, private Medicare plans often come with cost-sharing requirements, such as deductibles, and may occasionally require pre-approval from a doctor or hospital for coverage on certain tests or treatments.

Traditional Medicare imposes 20% coinsurance – a percentage of the medical costs that individuals must cover out of pocket. Beneficiaries can opt for MediGap, a supplementary insurance that covers these additional costs, which can accumulate after a hospital stay or medical procedure. Enrollment in MediGap is only available under specific circumstances, such as turning 65 or the first time signing up for Medicare.

Need Assistance with This Process?

You can visit the Centers for Medicare and Medicaid Services website to get fundamental information regarding enrollment and compare different Medicare plans.

Additionally, you can reach out to your state’s health insurance assistance program to connect with experts who can provide guidance. These specialists offer free advice to consumers.

There are personalized sessions available where you can ask questions about healthcare and prescription drug coverage. This directory can help you locate counselors in your state.

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