Medicare is seeing some important updates for 2025.
Medicare Updates for 2025
If you’re a Medicare beneficiary––or about to become one, the Fall Open Enrollment period from October 1st through December 15th is the time to review your plan and consider any changes to your coverage. Your annual notice of change letter, which you should have received around September, outlines the changes specific to your plan, so be sure to review it closely.
Here’s an overview of the biggest Medicare updates in 2025 and how they may impact your coverage.
1.) $2,000 Cap on Drug Costs Under Part D
For the first time, Medicare Part D will introduce an overall cap on out-of-pocket drug costs. Once your total out-of-pocket spending for prescription drugs reaches $2,000 for the year, you won’t pay anything more for the rest of the year.
This change is great news for those with high drug costs, as you will finally have an upper limit to your drug expenses for the year.
Learn More: What To Do When You Receive Your Annual Notice of Change Letter
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2.) Part D Deductibles and Premiums
In 2025, the maximum allowable deductible for Medicare Part D prescription drug plans increases to $590.
Once you meet this deductible, you’ll continue to pay copayments for your prescriptions, which will vary by the type of drug. Drugs available as generics will generally have the lowest tier, tier 1, and be available with a minimal copay, while more advanced drugs in tiers 2 through 4 will have a higher copay.
You’ll have to pay this copay each time you fill a prescription. However, once your total deductible and copay costs reach $2,000, you won’t have any more out-of-pocket costs for the rest of the year for your prescription drugs covered on your plan’s formulary.
Additionally, there’s a new premium cap for Part D plans—your premium cannot increase by more than 6% from year to year.
3.) The “Donut Hole” Disappears
The infamous Part D “donut hole” is going away in 2025.
This coverage gap has caused confusion and high out-of-pocket costs for many beneficiaries in the past. With the new rules, once you reach your deductible for the year, your costs will be more predictable, and there’s no more falling into a coverage gap.
4.) Expanded Coverage for Weight Loss Drugs
Weight loss drugs, like Wegovy, are now covered under Medicare, which is newly approved for weight loss alone, and not just diabetes.
However, these medications may come with high copayments. The good news is that the $2,000 drug cost cap will still apply to them, so you won’t be left with skyrocketing expenses.
5.) Mid-Year Statements from Medicare Advantage Plans
Medicare Advantage plans will now send mid-year statements showing the benefits you haven’t yet used. This will help you stay informed about your plan’s offerings and encourage you to take advantage of the services you’re entitled to.
6.) New Program for Caregivers of Dementia Patients
A new program called GUIDE (Guiding an Improved Dementia Experience) will launch in 2025 to support caregivers of dementia patients.
This program will offer resources and assistance, making it easier to care for loved ones with dementia. More supporting organizations will also be available to help families manage the challenges of caregiving.
Learn More: NEW! Expanded Medicare Benefits for Caregivers: What You Need to Know About the GUIDE Program
7.) Expanded Access to Mental Health Providers
If you’ve had trouble finding mental health providers, 2025 will bring expanded options.
Medicare is increasing the number of mental health professionals available, making it easier for beneficiaries to access care.
8.) Telehealth Benefits Made Permanent
During the pandemic, telehealth services became a vital resource.
Medicare is now making these benefits permanent, allowing you to continue using telehealth for doctor visits and other healthcare needs without the need for in-person appointments.
9.) Part B Premiums
The standard premium for Medicare Part B is currently $174.90, but it’s projected to increase in 2025. As of this writing, the official Medicare numbers for 2025 haven’t been fully announced yet. To get the latest from Medicare, and for more useful tips on getting the most from your Medicare benefits, bookmark the MediGap Advisors blog, and subscribe to the MediGap Advisors Health and Wealth newsletter!
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What To Do About These Medicare Updates
With all the changes happening in 2025, it’s important to take a close look at your Medicare Part D or Medicare Advantage plan to ensure it still fits your needs.
The $2,000 drug cost cap and the removal of the donut hole make Part D plans more predictable and potentially more affordable. If you or a loved one are dealing with dementia, the new GUIDE program could offer valuable support.
If you haven’t yet received your annual notice of change letter, reach out to Medicare or your plan provider to ensure you have all the latest information. Reviewing your coverage now can help you avoid any surprises in 2025.
For free personalized help and guidance in navigating the changes in Medicare, just make an appointment with one of our experienced MediGap Advisors Personal Benefits Managers.
The process is easy, stress-free, and we are frequently able to save our clients money, improve their medical coverage, or both. And there’s no charge, ever. Our fees are paid for by the insurance and health sharing organizations we represent.
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Lou Spatafore works for MediGap Advisors. As a PBM, his focus is to help people find the best Medicare plan for his clients. Read my full Bio.