Medicare Changes in 2025
Learn how new regulations impact benefits and costs, and how to ensure your plan meets your needs.
In 2025, Medicare will see major changes. New federal regulations aimed at protecting consumers and making Medicare more affordable will impact those enrolled in Medicare Advantage or Part D prescription drug plans, as well as those considering enrollment.
Beneficiaries should expect Medicare changes in benefits, including fewer supplemental benefits, tighter coverage restrictions, or even the discontinuation of some Medicare Advantage plans. Here’s a summary of the key Medicare changes in 2025 that could affect you and what steps you can take.
Medicare Advantage Changes
This year, more than half of eligible Medicare beneficiaries chose Medicare Advantage over Original Medicare. With this growing popularity, new rules will better protect consumers in 2025. For example, all Medicare Advantage plans must notify enrollees of unused supplemental benefits by July each year.
However, there may be challenging Medicare changes ahead. Though not all plans are affected, some Medicare Advantage plans may see reduced supplemental benefits or discontinuation in 2025.
Change | How It Affects You |
|---|---|
| Reduced plan options. Several major health plans have announced in their earnings calls that they will discontinue their Medicare Advantage plans in select states, potentially affecting up to 6 million Americans. | Your health plan will notify you by October 2 if your plan is discontinued, but your current coverage remains active until December 31. You’ll need to choose a new plan for 2025 during the upcoming Annual Enrollment Period, which runs from October 15 to December 7. |
| Reduced supplemental benefits. Some Medicare Advantage plans may impose stricter limits on supplemental benefits or eliminate them altogether. For example, some plans may require pre-authorization for certain procedures, which could delay care. If benefits are cut, you’ll need to pay out of pocket. | If you rely on benefits like dental or vision care, check your plan’s Annual Notice of Change (ANOC) this September to see if these will still be covered in 2025. There are also online tools and services like those provided by GoHealth that can help you review your benefits changes. |
| Reduced provider network. Some doctors and hospitals may leave the provider network of specific Medicare Advantage plans, reducing care options for plan enrollees. | If your preferred doctor, healthcare facility, or hospital leaves your plan’s network, you should be given at least a 30-day notice of that change. You can then pay out-of-network costs to stay with that same provider or switch to in-network providers. This can make it difficult to receive consistent care. |
| Increased premiums and out-of-pocket costs. Health plans warn of potential increases in premiums, deductibles, copays, and coinsurance for 2025 Medicare Advantage costs. | Review your plan’s Annual Notice of Change (ANOC) for 2025 cost updates. In addition to your premium, look over your deductible amount as well as out-of-pocket expenses for your most utilized benefits. |
New mid-year notification of unused supplemental benefits. Not all Medicare changes in 2025 are causes for concern. Starting next year, Medicare Advantage plans must send mid-year letters detailing unused supplemental benefits to help enrollees make the most of their plans.
| These notifications give you time to use benefits or assess which ones you don’t need, helping you evaluate your plan’s value. The letter will also include information on how to access unused benefits, including network information. |
My Medicare coverage doesn’t address all of my needs.
Part D Prescription Drug Plan Changes
Part D plans are offered by private insurance companies to help those with Medicare cover a wide range of prescription drugs. Recent reforms from the Inflation Reduction Act have introduced significant Medicare changes for those with a Part D plan.
Change | How It Affects You |
|---|---|
| Out-of-pocket maximum limited to $2,000. In 2025, all Part D plans will have a maximum out-of-pocket cost of $2,000, down from $8,000 in 2024. This is the most you will pay for your covered medications each year. Some Part D plans may have a lower out-of-pocket maximum, but no plan may set theirs higher than $2,000. | Part D enrollees will pay no more than $2,000 for their covered medications each year. After you have spent this much on your prescriptions, your Part D plan will pay for your medication costs for the rest of the year. |
| No more coverage gap phase. Currently, Part D plan members experience a coverage gap after spending $5,030 on their covered medications, but before they spend enough to meet their plan’s out-of-pocket maximum. During this gap, you pay up to 25% of the cost of your covered drugs instead of only paying the copay. This gap will be eliminated as part of the Medicare changes in 2025. | You’ll pay your deductible and copayments until you reach your Part D plan’s out-of-pocket maximum without the coverage gap in between. This keeps your overall drug expenses lower, as you will not have to pay more for your drugs aside from your usual out-of-pocket costs. |
| Base premium limited to 6% increase each year. The 2025 base premium for Part D plans will be $36.78, and this amount cannot increase more than 6% each year. The base premium is used to calculate late enrollment penalties for those put off enrolling in a Part D plan without an accepted reason. | While health plans set their own premiums, the federal base premium helps control the overall growth of Part D premiums. It also prevents the late enrollment penalty from increasing too much each year. |
New monthly payment option. Part of the Medicare Prescription Payment Plan, all Part D plans must offer an option to pay out-of-pocket drug costs in monthly installments over the year instead of paying the full cost upfront at the pharmacy.
| This option can ease financial strain by spreading payments throughout the year. You’ll need to enroll in the Medicare Prescription Payment Plan to use this method. |
Your Next Steps
If the Medicare changes in 2025 make your Medicare Advantage or Part D plan unsuitable for your needs or budget, you can switch to another plan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. During this time, you can change plans or switch back to Original Medicare. It’s also a good idea to reassess whether your plan still fits your needs, even if the plan details haven’t changed, as your circumstances may have.
For further guidance, contact your health plan’s customer care line or speak with a trusted licensed insurance agent. You may also take advantage of online tools and services, such as GoHealth’s PlanFit Checkup service, which can help you review your options.