If you're one of the tens of millions of Americans enrolled in Medicare, it's time to review your insurance options for next year.
Annual Medicare enrollment begins Tuesday and runs through Dec. 7. Enrollees can update or change their health insurance coverage during the intervening weeks.
Medicare is a federal health program for people age 65 and older and young adults with a disability or other qualifying medical condition. more than a little half of the elderlyapproximately 36 million people are expected to choose private Medicare Advantage plans over traditional government-run Medicare by 2025.
Under Medicare Advantage, insurance companies such as UnitedHealthcare and Aetna contract with Medicare to provide consumers with insurance plans that typically include a network of providers and impose cost-sharing requirements such as copays and deductibles. I'm doing it.
Tricia Newman, senior vice president at KFF, a nonprofit health policy organization, said private plan terms and in-network providers can change each year, so new and existing Medicare enrollees should He said he needed to check the plan.
“It's a good idea for beneficiaries to take the time to review their plans and compare their options to avoid unpleasant surprises next year,” said Newman, who runs the KFF program on Medicare policy.
How much does private Medicare cost?
The average premium for a Medicare Advantage plan that covers prescription drugs will be about $17 a month in 2025, down from $18.23 a month this year, according to a Medicare fact sheet.
Approximately 83% of enrollees will have the same or lower premiums in 2025 if they continue with their current plans. fact sheet He said Medicare would provide it.
Mary Beth Donahue, president and CEO of the Better Medicare Alliance, which represents private Medicare plans, said not all consumers will be able to keep their existing private Medicare plans.
Fewer than 1 in 10 consumers will need to purchase a new plan as their existing coverage plan is phased out. Ann analysis Roughly 2 million seniors on Medicare plans are estimated to lose coverage or no longer have services in their county in 2025, according to private research firm ATI Advisory. are. ATI estimates that 7% of consumers with private Medicare plans will need to purchase a new plan.
How will my plans change in 2025?
Some older adults may end up paying higher out-of-pocket costs as some Medicare plans cut supplemental benefits and raised deductibles. Donahue said private insurance companies are reducing coverage or changing their offerings in response to lower reimbursements from Medicare.
Donahue said private insurance companies mostly protect dental and vision benefits not provided by traditional government-run Medicare. However, some special needs plans reduce benefits that cover transportation and meals.
KFF analysis The average Medicare beneficiary will have a choice of 34 prescription drug plans in 2025, just two fewer than the 36 plans available in 2024, according to a report released Tuesday. Only.
How will prescription drug coverage change?
Good news for people who are prescribed medication for chronic illnesses. Consumers whose prescription drug costs exceed Medicare's catastrophic coverage limits will see significant benefits in 2025.
The Control Inflation Act of 2022, signed into law by President Joe Biden, will cap prescription drug copays for Medicare beneficiaries at $2,000 next year. The law also gave the federal government the power to negotiate prices for some of Medicare's most expensive drugs.
Private Medicare plans typically include prescription drug coverage. Premiums for consumers who choose traditional Medicare and also purchase Part D prescription drug coverage are expected to drop from $41.63 per month to $40 per month in 2024, according to Medicare documents.
This month's bipartisan report Congressional Budget Office Changes to prescription drug benefits were projected to increase federal spending more than budget analysts had originally expected. Now, CBO said the 2022 federal law will increase federal spending by an additional $10 billion to $20 billion next year.
How is private Medicare different from traditional Medicare?
Consumers who sign up for private Medicare rather than traditional government-run Medicare receive lower monthly premiums and additional benefits such as dental, vision, and gym memberships.
But choosing one of these plans comes with tradeoffs, said Newman, KFF's Medicare expert.
While traditional Medicare allows enrollees to choose from a wide variety of doctors and hospitals, private Medicare plans limit access to a narrow group network of hospitals, physicians, and labs. Private Medicare plans typically have cost-sharing requirements, such as deductibles, and may require doctors and hospitals to be approved by the plan to cover the cost of tests and procedures.
Traditional Medicare rates 20%coinsurance − The percentage of medical costs that consumers must pay out-of-pocket for treatment. If you have Medicare, you can purchase MediGap, a supplemental insurance plan that covers additional costs that may be incurred after surgery or hospitalization. Users can only enroll in MediGap under certain conditions, including: when they turn 65 Or when you sign up for Medicare for the first time.
Need help understanding this?
Visit the Centers for Medicare and Medicaid Services. Website Learn the basics about enrollment and compare Medicare plans.
Consumers can also contact their state's Health Insurance Assistance Program to connect with experts who can provide advice to consumers. Our experts offer free one-on-one sessions to answer your questions about medical care and prescription drug coverage. this list Help find a counselor in your state.
You can also visit nonprofit organizations Medicare Rights Center For registration and benefit consultation, please use our toll-free national helpline at 800-333-4114.
