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Older Americans have just days left to evaluate next year's Medicare coverage.
medicare annual Public recruitment period Medical insurance and prescription drug coverage will continue until December 7th. Experts say it's worth it for Medicare 67.8 million Beneficiaries need to ensure they receive the coverage that best suits their needs.
“This has never been a better time,” said Juliet Cubansky, associate director of the Medicare policy program at KFF, a health policy research firm.
Although many beneficiaries are satisfied with their plans and may be reluctant to make changes, it's still a good idea to consider all available options, he says.
“There's potential to save money,” Cubansky said. For example, you may be able to find a plan that reduces the cost of expensive medications or offers more coverage or additional benefits, she says.
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Beneficiaries must start with Medicare.gov According to Philippe Moller, once they started considering the plan, author “Make Medicare yours: Maximize your coverage and minimize your costs.”
Medicare.gov online plan finder Cubanski said it helps provide an overview of the plans available in a beneficiary's geographic area, as well as the monthly premiums and specific costs associated with the services provided through those plans.
Trained counselors also provide free Medicare advice in each state through the State Health Insurance Assistance Program, also known as SHIP.
Experts say there are some tips to keep in mind to effectively compare plans.
Make sure you have access to your preferred provider
Beneficiaries can choose Original Medicare (with the option to add Part D prescription drug coverage to Parts A and B) or a private Medicare Advantage plan.
Access isn't an issue under Original Medicare, Mueller said, because you can see any doctor in the country who accepts Medicare.
But Medicare Advantage plans have provider networks that limit the choice of doctors and hospitals that beneficiaries can choose from, he said.
It's best to check whether the doctor you want to see is covered by your plan, rather than assuming, Moller says.
Cubansky said the pamphlet may be out of date, so people should call their Medicare Advantage plan or health care provider directly to see if they're still covered.
Check if prescription drugs are covered
U.S. President Joe Biden speaks at an event on Medicare drug price negotiations in Prince George's County, Maryland, U.S., August 15, 2024.
Ken Cedeno | Reuters
From 2025, $2,000 annual out-of-pocket maximum Part D for prescription drug costs through Medicare.
This change is due to the Inflation Control Act, a federal law enacted in 2022.
As a result, about 8% of people who take expensive prescription drugs will end up paying more, but the remaining 92% may find ways to recover their benefits, Mueller said. said.
That could come in the form of higher copays and deductibles, or less generous plan benefits.
“Details are critical this year for Part D planning,” Mueller said. “People need to do their homework and make sure their Part D plan still does what they want.”
On average, Medicare Advantage plans will increase their deductibles for prescription drug coverage next year. Cubanski said the monthly average is typically about $50, but is expected to rise to just over $200 next year.
“Medicare Advantage enrollees, on average, will have higher deductibles for drug coverage in 2025,” Cubansky said.
Be careful about your out-of-pocket costs
Open enrollment gives beneficiaries the opportunity to control how much their overall out-of-pocket costs, including premiums, deductibles, and coinsurance, will increase in 2025.
“Make sure you have control over your annual out-of-pocket costs,” Mueller said.
Under Original Medicare, beneficiaries typically do not pay Medicare Part A premiums. However, in 2025, the standard monthly premium for Part B increases to $185 per month. This is an increase of $10.30 from this year's $174.70. The annual Medicare Part B deductible will increase to $257 in 2025, an increase of $17 from the $240 annual deductible in 2024.
In particular, Medicare Part B typically covers only 80% of physician and outpatient costs, which can place a financial burden on beneficiaries, Mueller said. Most people enroll in Medigap plans to cover costs that Medicare can't cover in full, he said.
Medigap, also known as Medicare supplement insurance, provides private insurance to help pay for out-of-pocket costs not covered by your original Medicare plan. According to one study, the average monthly Medigap insurance premium is $217. Recent KFF analysisHowever, the fees vary by state.
For Medicare Advantage, costs can vary by plan, and you may pay more to see an out-of-network doctor, Moeller said.
According to KFF, the average out-of-pocket limit for Medicare Advantage enrollees is $4,882 for in-network services and $8,707 for in-network and out-of-network services.
Bottom line: “Details matter,” Mueller said.
Medicare Original vs. Advantage: The choice is personal.
Medicare Advantage is share criticismThis is especially true when access to care is limited or unexpected costs encountered by some beneficiaries occur.
But experts say choosing between a private Medicare Advantage plan and the government's own Medicare plan is largely a personal decision.
“Medicare Advantage may be the right choice for some people,” Mueller said.
Medicare Advantage has certain benefits. It's generally less expensive for consumers than traditional Medicare with a Medigap plan, Moller said. Generally provides out-of-pocket protection against catastrophic medical expenses. It may also offer additional coverage for hearing, vision and dental, which traditional Medicare doesn't offer, he said.
However, Medicare Advantage enrollees may need prior authorization before receiving certain types of care, Cubansky said. In contrast, traditional Medicare typically does not use prior authorization.
Changes may be possible after December 7th
A senior citizen holds a sign during a rally to protect federal health programs during the 8th Annual Healthy Living Festival on July 15, 2011 in Oakland, California.
Justin Sullivan | Getty Images
In some cases, beneficiaries may still be able to make changes after Dec. 7, when Medicare open enrollment officially ends.
“December 7th is important, but it's not the be-all and end-all date in case we need to make some changes,” Mueller said.
Medicare Advantage has its own special open enrollment period that begins January 1st and runs through the first quarter. During that time, Medicare Advantage beneficiaries can switch to another Medicare Advantage plan, choose Original Medicare, or enroll in a standalone Part D drug plan.
Or, if you had a life-changing event, such as moving, you may be eligible for Medicare. Special enrollment period.
Additionally, people living in areas affected by hurricanes and wildfires in 2024 may take longer to obtain insurance in 2025. According to KFF.
