Many agents have asked this question year; What’s Different for AEP 2025. As we all know, Medicare AEP is a critical time for beneficiaries to review and adjust their health insurance coverage. The AEP takes place each year, from October 15th to December 7th. During this time, Medicare enrollees have the opportunity to make changes to their plans. This year’s AEP comes with some significant changes and updates that could impact coverage, costs, and benefits. Let’s go over some of the changes for Medicare AEP 2025.
Agents, click here to watch a quick YouTube video on strategies to manage this AEP
Medicare Part B Premiums and Deductibles
For 2025, the Medicare Part B premiums and deductibles will be adjusted as they have in previous years. The 2025 Part B premium is projected to increase about 5.9% to $185 per month. The deductible projection is approximately $257. This cost increase is largely due to inflation adjustments and increasing healthcare costs. Beneficiaries with higher incomes will also notice changes in their IRMAA (income-related monthly adjustment amounts). It is important for beneficiaries to review these updates and understand how they might impact their budget.
Changes to Part D drug plan benefits
The Medicare Prescription Drug (Part D) plans have made some significant changes. These changes will improve affordability for some beneficiaries:
- Removal of the Coverage Gap (Donut Hole) in 2025 there will be no coverage gap for PDP or MAPD plans.
- In 2025, catastrophic coverage begins once the beneficiary reaches the annual cap of $2,000 spent for prescriptions on their plan’s formulary.
- All plans that provide Medicare prescription drug coverage will be required to offer a payment plan option for beneficiaries. This will help enrollees spread out the cost of expensive prescriptions over the course of the plan year.
- The maximum deductible amount for PDP coverage will go up from $545 in 2024 to $590 in 2025.
- The $35 monthly insulin cost cap will continue in 2025. This ensures those with diabetes won’t pay more than $35 per month for insulin products covered under their Part D/MAPD plans.
- Necessary adult immunizations will be 100% covered by the plan providers. This includes flu shots, shingles shots and other adult immunizations.
- Some plan providers will no longer allow agents/brokers to sell their plans and plans will become non-commissionable.
- Some plan providers will leave the market all together while others will consolidate their product offerings.
Medicare Advantage Plans
- Many MA/MAPD plan providers will scale back benefits for 2025. This includes reductions in some dental and vision coverage amounts as well as a reduction in or removal of OTC benefits.
- Some MAPD plans will leave the market all together while others will reduce their market footprint. There are a few plans that will use this as an opportunity to expand their market area.
- The change in the number of available plans in certain areas may prove challenging for agents this year. It may be harder to find a plan that offers all the benefits your client wants as well as that their providers are in network with.
Expanded Coverage for Mental Health Services
There’s a growing recognition of the importance of mental health, and Medicare has responded by increasing its coverage for mental health services. More plans are now offering benefits like counseling, therapy sessions, and even virtual behavioral health services. This change addresses the rising mental health needs and to provides better access to care.
Medigap Policy Changes
While the main focus during AEP tends to be on Medicare Advantage and Part D plans, it’s important not to overlook Medigap (Medicare Supplement) policies. In some cases, AEP is a good time to see if clients are in the most cost-effective Medicare supplement available in their area. If another carrier offers the same plan at a lower cost, this is a great time to change plans.
Emphasis on Preventive Services
Medicare has increased focus on preventive care, encouraging beneficiaries to take advantage of annual wellness visits, vaccinations, and other screening services. Many preventive services are covered at no additional cost, depending on the plan. This makes it easier for enrollees to maintain their health without added expenses.
Key Takeaways for Beneficiaries:
- Review Current Coverage: Look at current Medicare Advantage, Medigap, and Part D plans, and see if the changes for 2025 affect coverage or costs.
- Compare Plan Options: This is the time to shop around. Use tools like the Medicare Plan Finder or a licensed Medicare agent to compare options and find the best plan for your needs and budget.
- Understand the New Benefits: Be sure to understand new benefits that may benefit you.
This year’s Medicare AEP brings many changes, as well as an attempt to make healthcare more affordable for some members.
It is always important to review your client’s plan options and provide assistance in navigating the changes. By staying informed, you can make the most of this year’s AEP and secure the healthcare coverage that best meets your client’s needs.
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