These Are The Changes Coming to Medicare in 2025

We’re only a couple of months away from Medicare’s annual open enrollment period, the time of year when Medicare patients can make changes to their plans.

In 2024, Medicare Open Enrollment is slated to take place between October 16 and December 7. The changes that those patients make to their medical plans and prescription plans will take effect on January 1, 2025.

As has always been the case, the new year promises to bring some changes to the Medicare program. Whether you’re on Medicare and looking to make some changes to your plan, or you’re helping care for a relative who is on Medicare and needs an extra set of hands when navigating the often complicated system, it’s crucial to understand as much about the annual changes as possible.

Today, discover more about the Medicare changes that are coming for patients in 2025 and how you can use some of those changes to your benefit, or the benefit of your loved one.

Lower Prescription Drug Costs

Some of the most prominent Medicare changes in 2025 focus on the Medicare Part D program. Part D is the Medicare plan that covers prescription drugs.

One of the changes that Medicare patients are most excited about is the lower out-of-pocket costs that patients can expect when they show up at the pharmacy counter.

Policymakers in Washington D.C. have been talking about passing legislation that would make prescription drugs more affordable for years, and 2025 appears to be the implementation of those plans.

For years, Medicare patients have found themselves experiencing sticker shock at the pharmacy when they find themselves in the coverage gap, a term that refers to a period where Medicare coverage stops paying for medications after paying a predetermined amount.

This year, that sticker shock may have the opposite effect, as patients can expect an out-of-pocket maximum. After a patient pays a certain amount on their annual prescription copays, their out-of-pocket cost will drop to $0.

This change is primarily targeted at patients who are on expensive medications and who have struggled to afford those meds, especially after the middle of the year.

Additionally, Medicare is expanding the eligibility for low-income subsidies (LIS). These subsidies currently exist to help cover prescription drug costs, which will help Medicare patients qualify for more assistance. This increased assistance leads to out-of-pocket costs before the maximum amount has been spent.

Finally, the federal government is actively engaged in negotiations with prescription drug manufacturers regarding their prices. This is a common practice among commercial insurance companies who come to cost agreements with drugmakers.

Ideally, these negotiations will result in Medicare having lower prices for certain, high-priced medications, and those savings will be passed onto the patient.

Take Advantage of Medicare Advantage Changes

Even if you don’t have a traditional Medicare plan, there are some potential changes heading your way. Medicare Advantage (Medicare C) plans are offered by private insurers in order to provide patients with an alternative option to traditional plans.

Some of these plans currently offer access to specialists who aren’t typically covered by Medicare Part D and additional coverage that focuses on specialized areas such as vision, dental, hearing, and more.

Beginning on January 1, 2025, Medicare Advantage companies will be legally required to offer better benefits to patients who struggle with chronic conditions. These comprehensive care management (CCM) programs are designed to improve outcomes for patients without requiring them to spend more on their healthcare.

Over the years, Medicare Advantage plans have received a lot of mixed reviews and scrutiny from insiders and the media alike.

The new regulations for Medicare Part C in 2025 will require these companies to be more transparent when it comes to their billing practices, advertising methods, and costs. The goal is to help patients better understand what’s happening with their coverage and in turn, their health.

In an effort to improve care and overall results, Medicare Advantage companies will be encouraged to take a deeper dive into some of the social determinants of health (SDOH).

As more information comes out surrounding the ways in which nutrition, transportation, housing, and other social factors impact health and healthcare.

By better understanding some of the external factors that are preventing patients from achieving optimal outcomes, Medicare Part C plans will be able to better help patients by equipping them with the tools that they need to overcome their obstacles.

Enhanced Mental Health Services

The importance of mental health is a hot-button topic right now. As the stigma surrounding mental health and the specialized care that it requires slowly fades, Medicare is taking steps to offer enhanced mental health services to its clients.

Thanks to countless studies that indicate that mental health is a major component of overall wellness, these changes are designed to help patients achieve optimal health in every area of their lives.

In addition to the mental health services that Medicare has already been providing coverage for, plans will expand to allow coverage for patients who see licensed professional counselors, marriage counselors, and family therapists.

Most of those areas are already dealing with a shortage of licensed professionals, and when you factor in the minimal coverage that Medicare has provided for these specialized services, it’s no wonder that many patients have been struggling to get the care that they need.

Medicare is also taking steps to combat the ongoing opioid epidemic by offering enhanced coverage for patients dealing with substance abuse disorders. This expanded scope of coverage is expected to cover in-patient and out-patient care services, as well as medication-assisted therapy (MAT) and comprehensive counseling services.

Telehealth Services Continue to Expand

It’s amazing to consider that only six years ago, the concept of telehealth seemed like some sort of futuristic idea that we would likely never see in our lifetimes.

The COVID-19 pandemic changed all of that, as it was considered unsafe for patients, especially elderly patients who make up most of the Medicare patient base, to sit in crowded doctor’s offices.

With this in mind, telehealth became a major component of healthcare in the US, but there were some hiccups initially as Medicare and providers struggled to learn how to build for office visits during which the patient never sat foot in the office.

In order to combat these issues, Medicare offered temporary coverage for some telehealth services. In 2025, many of those temporary coverage options will officially become permanent fixtures for most patients.

Patients will not only be able to continue seeing their primary care provider (PCP) via telehealth platforms, but the program will also expand its services, allowing patients to see more healthcare professionals from the comfort of their own homes.

As a way of getting doctors on board with expanding their telehealth offerings, Medicare will be offering increased reimbursements to providers who offer these services to patients.

Ideally, this will lead to Medicare patients who struggle to obtain consistent transportation seeing their doctors more regularly and improving their overall health.

Sometimes Change Is a Good Thing

Changes to Medicare programs come around every year as policymakers work with healthcare providers, drug companies, and others to provide quality care at a price that patients who are Medicare-eligible can afford.

Unfortunately, many of those changes are often confusing and some patients don’t even know about changes that have been made to their plans or the expanded services that they can now take advantage of.

Hopefully, this look at four of the major changes that are slated to take effect on January 1, 2025, will help you or the loved one in your life better navigate their health coverage and achieve better results.