BIG UPDATE: Medicare Beneficiaries Could Face Shock This Month From Plan Updates
Experts are cautioning that Medicare beneficiaries may face a jolt next month when they receive their annual notice of change, which outlines adjustments to their health care plans for the upcoming year.
Important Annual Notification
The annual notice of change arrives every October for Medicare recipients, providing essential information regarding modifications to their health care plans. This year, however, the alerts could be particularly surprising due to significant changes happening in both Medicare Advantage and Part D plans in 2025.
Alex Beene, a financial literacy instructor at the University of Tennessee at Martin, emphasizes the need for seniors to scrutinize their annual notices this year more than ever: “From year to year, that document may not carry as much weight as it does this year, as there are changes at the federal level, changes with the number of providers, and, sadly, changes to premium costs in the year ahead.”
Changes in Premiums and Plans
Seniors can expect considerable shifts in their monthly prescription plan premiums. Additionally, many Medicare Advantage plans will be disappearing as several insurers have announced their exit from select markets in 2025. For instance, top insurer Humana is set to leave 13 markets nationwide, affecting approximately 560,000 Americans who will need to find new Medicare Advantage plans.
Despite these exits, Louise Norris, a health policy analyst for medicareresources.org, reassures, “In most cases, there will still be Medicare Advantage plans available from other companies, even in areas where there might not be any Humana plans. So most enrollees will still be able to be covered by Medicare Advantage if that’s their choice.”
Key Changes Ahead
The Biden administration has approved a $2,000 out-of-pocket maximum for Part D drug costs starting in 2025, meaning seniors will not pay more than $2,000 on their prescriptions throughout the year. Furthermore, individuals relying on insulin will only pay $35 per month under the new law.
While this is positive news for seniors with extensive medication needs, it may lead to increased rates on Medicare Advantage plans or reduced coverage as insurers seek to maintain profit margins in light of the new drug cost cap. Additionally, insurance companies are facing a lower increase in government payments for 2025, which could shift some costs onto patients.
As a result, seniors may encounter higher drug deductibles, copays, and premiums in 2025. Insurers also anticipate increased utilization of supplemental benefits, such as over-the-counter (OTC) cards and dental services. Humana’s Chief Financial Officer Susan Diamond noted during a recent Wells Fargo Healthcare Conference that they expect elevated use of these services, especially as benefit changes for 2025 are recognized.
Navigating the Changes
Both UnitedHealth and Mutual of Omaha are preparing for significant adjustments due to changes in government funding for 2025. UnitedHealth’s CEO, Andrew Witty, expressed that their strategy focuses on maintaining stability in a reduced funding environment, while Mutual of Omaha announced it would discontinue its standalone Medicare prescription drug plans due to rising costs from the Inflation Reduction Act.
Beneficiaries should carefully review their annual notice of change, which will include updates on in-network providers and pharmacies, drug lists, and cost changes.
Beene warns, “Normally, seniors just look at the price tag and may not do an overview of other alterations that can actually have more of a long-term effect on your coverage than the few dollars more you’re going to be paying. This year they need to.”
Also Read: Spotted Lanternfly Alert: Quarantine Areas in Ohio
