Medicare Open Enrollment: Key Changes For 2025

Open Enrollment is underway for Medicare, and there are some changes this year to know about. Kelly McEver from Community Care spoke to News On 6's Dave Davis about the changes.

Dave: Tell us, what are some big changes for open enrollment this year?

Kelly: The big change this year is all about the drugs. Everyone’s heard about the donut hole or coverage gap. That’s finally going away in 2025, and the most Medicare beneficiaries will pay for outpatient prescription drugs will be $2,000.

Dave: So, out-of-pocket drug costs for seniors are going down. That’s monumental.

Kelly: Yes, it’s exciting! There's also a program that lets people annualize that $2,000 cost so they pay nothing upfront for their drugs and get billed monthly by their insurance carrier.

Dave: That’s great. How is Community Care communicating these changes to members?

Kelly: Every year, anyone on a Medicare Advantage plan receives an Annual Notice of Change detailing updates to premiums, out-of-pocket amounts, copay changes, benefits, and drug costs. If members haven’t received it, they should call their carrier for a copy.

Dave: And there are federal regulations around it, right?

Kelly: Yes, they require members to be notified of changes by October 1 every year.

Dave: What kinds of concerns are you hearing early in the process?

Kelly: One big concern from seniors is unexpectedly being switched to a different plan after calling 800 numbers from national commercials. Please protect yourself. Do not call those numbers. All that's going to happen is you're now falling into some national brokerage chain to where there's concern about sales and not about you. If you're shopping for insurance, use a local insurance agent or call the carrier directly,

Dave: That’s important because if someone’s doctor was in-network last year, switching plans without knowing the details can mean paying out of pocket.

Kelly: Exactly. And that's a big, big concern, and that's one of the things that we want to emphasize to people who are shopping during this time. The thing you're shopping for is health insurance. So you want to look at your doctors and your drugs. Everybody gets kind of distracted by the shiny objects. "Oh, I might get gas and utilities paid for", maybe, but typically not unless you also have Medicaid. So make sure you're looking at doctors and drugs, then choose your plan.

Dave: Let’s talk about premiums. How are they looking this year compared to last?

Kelly: Many carriers still offer plans with no monthly premium for 2025, and some have even lowered premiums. Others have increased, so it’s essential to review your Annual Notice of Change. The Part B premium, which Medicare Advantage enrollees also pay, hasn’t been released yet—usually, that’s available mid-November.

Dave: So, for Medicare, do people go directly through Medicare, or do they often choose Advantage plans?

Kelly: We're seeing more and more people choose Medicare Advantage plans. So a Medicare Advantage plan is also called Part C, and it's also called a replacement plan. What a Medicare Advantage plan does is replace who's paying the claims. We take all of the Medicare A and B coverage. What's covered through Medicare A and B is here. Include the drug coverage, add on the extras, and then any claims that are paid come through the carrier rather than going through Medicare. So it's an all-in-one plan. When you can on a Medicare Advantage plan, you only show your plan card.

Dave: Anything else people need to know before finalizing their choices? What’s the deadline?

Kelly: If you have Medicare Parts A and B, the deadline to make a choice for January 1 is December 7. If you don’t act, you’ll stay on your current plan. However, if you’re planning to retire at the end of the year, you have a special election period. You have a special election period for that. And if you're on a Medicare Advantage plan, you miss your enrollment opportunity, you forget or somehow you got switched. Another open enrollment period from January 1 through March 31 is called the Medicare open enrollment period. We call it the oops period.

Dave: But let’s aim for December 7 to avoid any issues.

Kelly: Absolutely, and the sooner, the better. We get a lot of calls between Black Friday and December 7, so make your choice now.