Medicare Advantage plans continue to evolve with significant changes for 2025 that could impact your healthcare coverage and costs.
Key Takeaways
- $2,000 prescription drug cap: Medicare now limits your annual out-of-pocket prescription costs to $2,000 starting in 2025.
- 67% of Medicare Advantage plans charge $0 premium beyond your Medicare Part B premium.
- 32% of plans now offer Part B premium reduction, up from just 19% in 2024.
- Some supplemental benefits declining: Plans are reducing offerings like over-the-counter benefits and meal programs.
- New payment plan available: Spread prescription costs throughout the year with the Medicare Prescription Payment Plan.
Medicare Advantage 2025 Overview
Medicare Advantage plans in 2025 continue evolving with significant changes affecting costs, benefits, and coverage options for Medicare beneficiaries.
Get a Free Medicare Supplement Quote
What’s New for Medicare Advantage in 2025
Medicare Advantage continues changing more rapidly than traditional Medicare options. Here are the most significant updates for 2025:
Major Prescription Drug Changes
Starting in 2025, Medicare limits your annual out-of-pocket prescription drug costs to $2,000. Once you reach this amount, you pay nothing for covered medications for the rest of the year.
The Medicare Prescription Payment Plan lets you spread prescription costs into smaller monthly payments instead of paying large amounts at the pharmacy. You can enroll anytime during the year at no extra charge.
Premium and Benefit Updates
Two-thirds (67%) of Medicare Advantage plans with prescription drug coverage charge no premium beyond the Part B premium in 2025, similar to 2024.
However, 32% of Medicare Advantage plans now offer some reduction in the Medicare Part B premium in 2025, a significant increase from 19% in 2024.
Declining Supplemental Benefits
While nearly all plans (97% or more) still offer vision, dental, and hearing benefits, some popular extras are becoming less common:
- Over-the-counter benefits: Down from 85% to 73% of plans
- Remote access technologies: Dropped from 74% to 53% of plans
- Meal benefits: Decreased from 72% to 65% of plans
- Transportation: Reduced from 36% to 30% of plans
2025 Special Needs Plans Updates
Special Needs Plans continue expanding in 2025 with important changes for beneficiaries with specific health conditions or dual Medicare-Medicaid eligibility.
Growth in Dual-Eligible Special Needs Plans
The number of Dual-Eligible Special Needs Plans (D-SNPs) continues growing rapidly, nearly doubling from 465 to 851 plans between 2019 and 2024.
Lower D-SNP Look-Alike Threshold
Medicare Advantage plans serving high percentages of dual-eligible individuals now face stricter requirements. The D-SNP look-alike threshold dropped from 80% to 70% in 2025 and will decrease to 60% in 2026.
2025 Cost and Coverage Changes
Several significant cost and premium changes affect Medicare Advantage beneficiaries in 2025.
Zero Premium Plans Remain Common
Two-thirds (67%) of Medicare Advantage plans with prescription drug coverage charge no premium beyond the Part B premium in 2025, maintaining similar levels to 2024.
Nearly all beneficiaries (99%) have access to a Medicare Advantage plan with no additional monthly premium in 2025.
Part B Premium Reductions Increase
Thirty-two percent of Medicare Advantage plans now offer some reduction in the Medicare Part B premium in 2025, a significant increase from 19% in 2024.
Average Premium Costs
CMS estimates the average monthly plan premium among all Medicare Advantage enrollees in 2025 will be $17.00 per month, including those who pay no premium for their Medicare Advantage plan.
2025 Quality and Regulatory Improvements
Medicare continues implementing stricter oversight and quality improvements for Medicare Advantage plans in 2025.
Enhanced Appeals Process
CMS revised regulations to require Quality Improvement Organizations (QIOs), instead of Medicare Advantage plans, to review untimely fast-track appeals for service terminations in skilled nursing facilities and home health agencies.
Star Ratings Updates
The 2025 Star Ratings include minor methodological changes, with increased weight for the Part C Plan All-Cause Readmissions measure from one to three points.
Get a Free Medicare Advantage Quote
Select whether you would like quotes on Medicare Advantage and MAPD plans, or Part D prescription plans.
Stay Informed About Medicare Advantage Changes in 2025
The significant updates to Medicare Advantage plans in 2025—including the prescription drug spending cap, payment plan options, and changes to supplemental benefits—require careful evaluation of your Medicare coverage.
Understanding these changes helps you make informed decisions during the Annual Open Enrollment Period (October 15 – December 7) when you can modify your Medicare Advantage coverage for the following year.
Don’t navigate these 2025 Medicare Advantage changes alone. Schedule a free consultation with one of our Medicare Personal Benefits Managers today. Our experts stay current on all Medicare updates and provide personalized guidance to help you understand how the 2025 changes affect your specific situation.
Discover which Medicare Advantage options work best for your 2025 healthcare needs with a free consultation. Call (800) 913-3416 or schedule your appointment online today.
For Further Reading:
How does the new $2,000 prescription drug cap work in Medicare Advantage plans?
Once you spend $2,000 on covered prescription drugs in 2025, you pay nothing for the rest of the year. This applies to 88% of Medicare Advantage plans that include prescription coverage.
Can I use the new Medicare Prescription Payment Plan with Medicare Advantage?
Yes, you can spread your prescription costs into monthly payments instead of paying large amounts at the pharmacy. Contact your Medicare Advantage plan to enroll anytime during the year.
Why are some supplemental benefits being reduced in 2025?
Plans are cutting certain extras like over-the-counter benefits and meal programs, partly due to regulatory changes and payment rate adjustments from CMS.
What's new about Part B premium reductions in 2025?
Thirty-two percent of Medicare Advantage plans now offer Part B premium reductions, up significantly from 19% in 2024.
Whitney Kline is one of your Personal Benefits Managers at Medigap Advisors. She loves working for Medigap Advisors especially helping clients choose the right Medicare plan.