With the 2025 Medicare enrollment now open, significant changes are on the horizon for the program, often referred to as “the Red and Blue Card.” According to experts, many beneficiaries tend to stick with their current plans rather than actively compare options. David Lipschutz, Co-Director of the Center for Medicare Advocacy, emphasizes the importance of staying informed about these changes. “Every year we stress this, but with the changes from the Inflation Reduction Act, it’s essential to shop around and ensure that your medicines are still covered under your plan,” he advises.
Lipschutz points out that beneficiaries of Medicare Advantage plans and Part D private plans stand to gain the most from being proactive and engaged. “Often, people don’t compare options at all or just glance at them once and feel they’ve done their part, only to continue with their existing plan. This inertia can be a major barrier to making necessary changes.”
So, how can individuals prepare for the changes to Medicare for the upcoming year?
1. **Review the Annual Notice of Change (ANOC)**
This important document outlines the adjustments to Medicare Advantage plans for 2025, including lists of in-network providers and pharmacies, updates on covered medications, and any price changes. Beneficiaries can make adjustments to their coverage during the open enrollment period from October 15 to December 7, with the Medicare Advantage enrollment running from January 1 to March 31.
2. **Examine Drug Coverage and Costs**
Medication tiers can affect out-of-pocket expenses. When reviewing the ANOC, it’s crucial to check if the prescriptions you currently take have been moved to a different tier. Ensuring that your medications remain covered is vital. Lipschutz recommends consulting with an insurance agent to review all medications and identify the most suitable plan; alternatively, beneficiaries can visit Medicare.gov to input their current medications or call 800-MEDICARE for personalized assistance.
3. **Understand the Changes to Medicare Advantage Plans**
These plans often offer more supplemental benefits than traditional Medicare, but it’s important to know which existing benefits will continue in 2025. Just because a Medicare Advantage plan offers specific benefits doesn’t mean every beneficiary can utilize them; limitations often apply, such as being restricted to particular provider networks, while traditional Medicare may allow broader access to doctors. Be sure to ask detailed questions to understand what benefits you can actually access.
4. **Conduct a Comprehensive Cost Review**
In addition to monthly premiums, out-of-pocket costs, copays, and the convenience of accessing services all play a role in shaping your budget. Beneficiaries need to assess whether they can manage any changes in premiums, provider networks, pharmacy access, maximum out-of-pocket amounts, copays, or coinsurance. Lipschutz advises against choosing a plan based solely on low premiums, as this often leads to higher overall costs and incomplete prescription drug coverage.
In short, doing your homework regarding Medicare options can pay off significantly in ensuring you have the right coverage for your needs.
