The landscape of healthcare is continually changing, and Medicare is no exception. With Medicare’s Annual Enrollment Period happening, it is important for you to know about several significant changes happening in 2025. Whether you’re already enrolled in Medicare or considering your options, understanding these updates is crucial for navigating your healthcare needs effectively. Below are two key changes to Medicare in 2025 and what they mean for you.

1. Enhanced Prescription Drug Coverage

Prescription drug costs have been a significant burden for many Medicare patients. In response, Medicare has enhanced prescription drug coverage in 2025, aimed at making medications more affordable and accessible.

Some of the key changes include:

• Lower Out-of-Pocket Costs: The new changes include a $2,000 cap on out-of-pocket expenses for prescription drugs if you have a Medicare Part D plan. In addition, Part D enrollees will have the option of spreading out their out-of-pocket costs over the year rather than face high out-of-pocket costs in any given month. 
• Increased Generic Options: Medicare will encourage the use of generic drugs by offering lower copayments for these medications. This will reduce overall drug costs while maintaining the same therapeutic benefits.
• Simplified Formulary: The formulary, or list of covered drugs, will be simplified to reduce confusion and make sure that essential medications are easily accessible. This includes a more transparent process for adding new drugs to the formulary. 
• Enhanced Medication Therapy Management (MTM): MTM services will be expanded to help beneficiaries manage their medications effectively. This includes personalized consultations with pharmacists to optimize drug therapy, reduce adverse effects and improve adherence.

2. Midyear notification to those with Medicare Advantage plans 

Patients aren’t using all their benefits, studies show. A Commonwealth Fund study found that three in 10 Medicare Advantage members didn’t use any of their supplemental benefits in the past year.

Due to the low use of supplemental benefits, CMS has determined that in 2025, Medicare Advantage plans will be required to send everyone in the plan a personalized “Mid-Year Enrollee Notification of Unused Supplemental Benefits” in July. This notification will include:

• A list of all supplemental benefits the person hasn’t used to date.
• The scope and out-of-pocket cost for claiming each one.
• Instructions on how to access the benefits.
• A customer service number to call for more information.

Preparing for the upcoming changes

While the above are two of the biggest changes to Medicare in 2025, they are not the only changes, and each plan may have additional changes to benefits and cost. Therefore, it is important to complete the following tasks to make sure you are well-prepared to make the most of your healthcare coverage in 2025.

1. Review Your Plan Annually.
2. Visit the Official Medicare Website for resources to help you understand your coverage, compare plans and make informed decisions.
3. Consult with a Licensed Medicare Agent if you have any questions.

The changes to Medicare in 2025 are designed to improve the overall healthcare experience for Medicare recipients. By understanding these updates and preparing accordingly, you can make the most of your Medicare coverage. Remember, staying informed and proactive is key to navigating the complexities of Medicare successfully.

Medicare's Annual Enrollment Period (AEP) is Oct. 15 – Dec. 7. For more information on Medicare and what’s best for you… Summit Health has partnered with an independent licensed agent. To learn more, please click here.