"As fall arrives, we prepare for the inundation of television ads for the annual Medicare Open Enrollment Period," stated professional fiduciary and certified elder law Attorney RJ Connelly III. "This period, which runs from October 15 to December 7, allows individuals to switch between original Medicare and a Medicare Advantage plan, or vice versa. It also allows selecting a new Advantage plan or a new Medicare Part D prescription drug coverage."
"Staying informed about the upcoming changes to Medicare for 2025 will help you make well-informed decisions when it comes time to choose a plan or remain with your current one," Attorney Connelly continued. "Given that Medicare plans can undergo annual modifications and individual healthcare needs may change, the annual Medicare Open Enrollment Period is critical for reviewing and adjusting current Medicare coverage."
What You Can Do
During Medicare Open Enrollment 2025, you have several options available to you:
Individuals can transition from Original Medicare to a Medicare Advantage plan or from a Medicare Advantage plan back to Original Medicare at their discretion.
Individuals can switch from one Medicare Advantage plan to another during specific times throughout the year, typically during the annual or other designated special enrollment periods.
Individuals can transition from a Medicare Advantage plan lacking prescription drug coverage to a Medicare Advantage plan inclusive of prescription drug coverage or vice versa.
You can enroll in a Medicare prescription drug plan.
As per Medicare guidelines, you can transition from one Medicare drug plan to another if your current plan no longer aligns with your requirements.
If an individual no longer desires to maintain Medicare prescription drug coverage, there is the option to terminate enrollment from the program voluntarily.
"There are some things to be aware of when transitioning back to Original Medicare during the annual enrollment period; it's important to consider potential increased costs or coverage denial when acquiring a Medicare Supplement Insurance (Medigap) policy," said Attorney Connelly. "Also, remember that upon enrolling in Medicare Part B, there's a six-month window to get a Medigap policy regardless of health status, except in four states. After this period, providers may require a medical evaluation, apply higher premiums, or decline coverage based on health concerns."
What You Can't Do
Individuals who are not currently enrolled in Medicare do not have the opportunity to enroll during the Medicare open enrollment period. This period is specifically designated for individuals who are already enrolled in Medicare. Eligible individuals must enroll during their initial enrollment period, Medicare's general enrollment period, or a special enrollment period. It is essential to understand these enrollment periods to ensure timely access to Medicare benefits when needed.
Three Medicare Changes for 2025
"There are some modifications to Medicare that are expected to have far-reaching implications for beneficiaries in 2025," stated Attorney Connelly. "In today's blog post, we will analyze the three most pertinent modifications. These changes will involve the spending thresholds for prescription drugs, the introduction of supplementary improvements aimed at enhancing the quality of healthcare for senior citizens, and some of the issues with the sale of Medicare Advantage plans. I cannot stress enough the importance of Medicare beneficiaries staying informed about these and other changes to ensure uninterrupted access to comprehensive healthcare coverage for 2025. Let's take a closer look at these changes."
New $2,000 annual cap on out-of-pocket prescription costs
Starting in 2025, individuals with Part D plans will have a $2,000 cap on out-of-pocket costs. This cap may increase annually after 2025 based on the per capita Part D cost growth. Enrollees can spread out their costs over the year. The new rule only applies to medications covered by the Part D plan and does not include out-of-pocket spending on Medicare Part B drugs. If you are enrolled or considering enrolling in Medicare Part D plans in 2025, carefully review your options using the Medicare Plan Finder to ensure your prescriptions are covered. This change may impact individuals with employer-provided prescription drug coverage. It's worth noting that the $2,000 cap may lead to more stringent prescription requirements, limitations on covered medications, and increased Part D premiums and co-pays.
Midyear notification to Medicare Advantage policyholders
Medicare Advantage plans often offer additional coverage than traditional Medicare, such as dental, vision, hearing, and fitness benefits. However, a study found that three in 10 Medicare Advantage beneficiaries did not use their plan’s supplemental benefits. Starting in 2025, Medicare Advantage plans will be required to send policyholders personalized notifications of unused supplemental benefits in July. Low utilization of supplemental benefits could be due to difficulties in finding preferred healthcare providers within the plan's network or a lack of awareness about available benefits.
Agents and brokers selling Medicare policies are facing scrutiny
The Centers for Medicare & Medicaid Services (CMS) has announced its intention to discontinue sales incentives for Medicare Advantage and Part D plans by 2025. This decision will eliminate bonuses and extravagant incentives for salespeople who enroll beneficiaries into private insurers' plans. The primary objective of this new regulation is to prioritize the best interests of Medicare beneficiaries by imposing a cap on salespeople's compensation and prohibiting excessive administrative fees for brokers and agents. Senate Finance Committee Chairman Ron Wyden has expressed support for the rule. However, some consumer activists have voiced concerns regarding potential incentives that may lead individuals to opt for Medicare Advantage plans despite these changes. In essence, the new rule is designed to ensure that agents and brokers place the needs of potential enrollees at the forefront and refrain from favoring specific plans due to financial incentives. It is imperative for consumers to pose fundamental inquiries when engaging with a broker and to utilize Medicare's Plan Finder tool to explore all available plan options in their respective areas thoroughly.
State Health Insurance Assistance Program (SHIP)
"The open enrollment period can lead to confusion and misinformation, especially given the pervasive advertising of Medicare Advantage plans on television and their multitude of promises," Attorney Connelly said. "I strongly advocate for those unsure about their plans or what is best for their situation to contact your State Health Insurance Assistance Programs (SHIPs) that provide comprehensive and impartial insurance counseling and support to eligible Medicare beneficiaries, their families, and caregivers. These state-based programs offer personalized one-on-one counseling and assistance to aid individuals in making well-informed decisions regarding their Medicare coverage. Click here to find the SHIP program in your state."
A Final Thought
"It is imperative to recognize the significance of the open enrollment period for individuals with Medicare and to assess available options carefully," said Attorney Connelly. "Maximizing the benefits of your Medicare Advantage plan, particularly if it encompasses a wide array of advantages, is critical. If you are underutilizing the supplementary benefits, I would advise you to consider transitioning to a plan that aligns better with your current needs. Discovering an alternative plan that offers essential benefits at a more cost-effective rate or delivers specialized benefits not included in your current plan is possible. Begin exploring these options in mid-October to allow sufficient time for comparison, as this may result in substantial healthcare cost savings in 2025."
Please note that the information provided in this blog is not intended to and should not be construed as legal, financial, or medical advice. The content, materials, and information presented in this blog are solely for general informational purposes and may not be the most up-to-date information available regarding legal, financial, or medical matters. This blog may also contain links to other third-party websites that are included for the convenience of the reader or user. Please note that Connelly Law Offices, Ltd. does not necessarily recommend or endorse the contents of such third-party sites. If you have any particular legal matters, financial concerns, or medical issues, we strongly advise you to consult your attorney, professional fiduciary advisor, or medical provider.
Comments