Brace yourselves for benefit reductions and or cost increases on Medicare Advantage plans in 2025.
Most people on these plans have experienced steady improvements in these plans over the past 12 years. Lower costs, lower out of pocket maximums have been the trend.
Plans have added dental, vision, hearing, transportation, personal emergency response devices, over the counter allowances and a plethora of other benefits.
For next year it looks like reimbursements for Medicare Advantage plans are going down. These are the payments these plans get from the government for each person enrolled.
Many plans had their Star ratings reduced in 2024 and a commensurate reduction in their reimbursements.
Due to the 2022 Inflation Reduction Act plans will be forced to absorb much more in drug costs. In 2025 there will be a cap of $2000 on what each person will have to spend for “Part D” drug costs. This cost will be borne by these plans.
CMS “final rule” may also add more costs to these plans in 2025.
It’s possible plans might choose to absorb this cost and not raise costs or reduce benefits, but that seems unlikely.
What should you do?
#1. Take full advantage of all the extra benefits you have in 2024. Don’t assume any benefits will still be on the plan in 2025.
#2. Do Not call your carrier or agent or provider right now and ask what to do. We won’t know anything until July and probably won’t have any sort of clarity until October.
#3. Watch for communications from your health plan. In September you should receive your Annual Notice of Change. This document will spell out any changes in your plan.
#4. Watch for changes in the provider network. We had some significant disruption in plans in 2024 due to some provider groups dropping their contract with Medicare Advantage plans.
#5. Get in touch with your primary care doctor and/or medical group and find out what plans they will be contracted with for 2025.
#6. Don’t immediately think of changing to another plan. Every plan will be under these pressures and we don’t know if there will be any “safe havens” to switch to.
#7. Around September It would be prudent to load all your drugs into your mymedicare.gov account or whatever platform your agent uses. This will allow price comparisons based on your drug regimen.
#8. Plans release information October 1, but we find it’s best to wait until October 15 for the dust to settle to start shopping and comparing plans.
#9. When shopping for a Medicare Advantage plan you want to:
- Search for plans that allow you to see the doctors you want to continue to see.
- Make sure your preferred hospital in the network?
- Compare drug costs. Look at the “preferred pharmacies” for your plan. Even within their preferred network prices can vary.
- What is the MOOP? Maximum Out of Pocket for 2025
- What are the copays for services you expect to need?
- What extra benefits do the plans offer that you will actually make use of.
Is it time for a change of plans? Perhaps it may be time to consider a Medicare supplement plan.
In California: If your Medicare Advantage plan has more than a 15% increase in cost or a 15% reduction in any benefits you will be able to enroll in a Medicare Supplement plan on a guaranteed basis during the Annual Election Period. These plans have a significant monthly premium, but they provide unfettered access to a national network of Medicare contracted providers. On these plans the insurance company has no say so in your course of treatment. I’ve never seen something that required prior authorization on these plans. On these plans the carriers are told by Medicare how much to pay and to whom. Sorry, they don’t come with many bells and whistles. The plan we most commonly recommend is plan G and this year the out of pocket maximum is $240.
Paul Davis is an Independent Insurance Agent specializing in Medicare Health plan options. Supporter of ONE generation since 2003. CA licensed since 1985. 0669770. www.pdinsure.com 818 888 0880.