Key Takeaways:

• Medicare coverage has changed in 2025, including updates to prescription drug costs, premiums, and plan structures. You need to understand these changes before making decisions during Open Enrollment.

• Reviewing your plan details and comparing options ensures you get the best coverage for your needs. Be aware of new caps on drug expenses, premium adjustments, and evolving benefits.

Understanding Medicare Coverage Changes in 2025

Medicare undergoes adjustments every year, and 2025 is no different. If you’re a Medicare beneficiary, it’s crucial to stay informed about what’s changing so you can make the right choices during Open Enrollment. From cost adjustments to new coverage options, here’s everything you need to know.

Higher Medicare Part B Premiums and Deductibles

One of the most notable updates for 2025 is the increase in Medicare Part B costs. If you’re enrolled in Part B, expect:

• A standard monthly premium of $185 (up from 2024)

• An annual deductible of $257

Higher-income beneficiaries will continue to pay more through the Income-Related Monthly Adjustment Amount (IRMAA). If you fall into this category, be sure to check the updated income brackets to see how your premiums may be affected.

Medicare Part A Cost Adjustments

Medicare Part A, which covers hospital stays, skilled nursing facilities, and hospice care, has also seen changes. Here’s what’s different in 2025:

• The inpatient hospital deductible is now $1,676 per benefit period.

• Daily coinsurance rates have increased to $419 for days 61-90 and $838 for lifetime reserve days.

• Skilled nursing facility care now has a daily coinsurance of $209.50 for days 21-100.

These adjustments emphasize the importance of planning for potential hospital stays and out-of-pocket expenses.

The Big Change: Medicare Part D Out-of-Pocket Cap

One of the biggest shifts in 2025 is the elimination of the Medicare Part D coverage gap (also known as the donut hole). Instead of moving through multiple cost phases, beneficiaries now have a new structure:

• You pay your plan’s deductible (up to $590 in 2025).

• You move into the initial coverage phase, where you pay a share of your prescription drug costs.

• Once you hit $2,000 in out-of-pocket drug expenses, your plan covers 100% of all covered medications for the rest of the year.

This means you’ll no longer be stuck with high medication costs after reaching a certain spending level. If you take multiple or expensive prescriptions, this is a game-changer.

Medicare Advantage Plans: What’s Changing in 2025?

Medicare Advantage plans (Part C) see some adjustments in 2025, although they vary by location and provider. Key trends include:

• Stable or slightly decreased premiums for many enrollees

• Changes in out-of-pocket limits, with the maximum in-network spending cap now $9,350

• Reductions in supplemental benefits such as over-the-counter allowances and transportation services

If you have a Medicare Advantage plan, carefully review your Annual Notice of Change (ANOC) to see how your specific plan is changing.

Mid-Year Notifications for Unused Benefits

A new rule introduced in 2025 requires Medicare Advantage plans to send out a Mid-Year Enrollee Notification of Unused Supplemental Benefits between June 30 and July 31. This notice will tell you which extra benefits—like dental, vision, hearing, or fitness programs—you haven’t used yet. It’s designed to encourage enrollees to take advantage of all the perks their plans offer.

Prescription Drug Cost Payment Plan

A new feature introduced this year is the Medicare Prescription Payment Plan, which allows you to spread out your out-of-pocket drug costs over monthly payments instead of paying large amounts at once. This is an optional program, so check if your plan offers it and if it’s right for you.

Medicare Supplement (Medigap) Policy Updates

Medigap policies remain an important option for those with Original Medicare, but in 2025, premium adjustments and benefit changes may apply. Medigap plans help cover costs like copays and deductibles, but they vary by state. If you have a Medigap policy, review your coverage during Open Enrollment.

What to Expect During Open Enrollment

Medicare Open Enrollment runs from October 15 to December 7, 2025. During this period, you can:

• Switch between Original Medicare and Medicare Advantage

• Change your Medicare Advantage plan or Part D prescription drug plan

• Enroll in a new plan if your current plan is no longer available

It’s crucial to compare plans during Open Enrollment because plan benefits and costs can change every year. Even if you like your current plan, reviewing your options ensures you’re still getting the best coverage.

How to Make the Right Medicare Choices in 2025

With so many changes, it’s important to approach Open Enrollment with a strategy. Here’s what you should do:

1. Review your current plan’s changes – Your insurer will send an Annual Notice of Change (ANOC) explaining cost and benefit adjustments.

2. Compare your options – Medicare’s Plan Finder tool or a licensed Medicare professional can help you evaluate new plans.

3. Check your prescription drug coverage – Make sure your medications are still covered and see how the new $2,000 cap affects you.

4. Verify your doctors and providers are in-network – If you have Medicare Advantage, ensure your preferred healthcare providers still accept your plan.

5. Consider your health needs – If your health has changed, you may need a plan with better coverage for certain conditions.

Key Deadlines to Keep in Mind

• June 30 – July 31, 2025: Medicare Advantage plans send Mid-Year Enrollee Notifications for unused benefits.

• October 15 – December 7, 2025: Medicare Open Enrollment period.

• January 1, 2026: Changes made during Open Enrollment take effect.

Get Ready for Medicare Open Enrollment

With all these changes, taking time to evaluate your Medicare plan for 2025 is essential. Whether it’s the new Part D cost cap, premium increases, or Medicare Advantage adjustments, understanding what’s new ensures you make the best choices for your healthcare needs.

If you’re unsure about your options, speak with a professional listed on this website. They can help guide you through the changes, compare plans, and ensure you’re enrolled in the best coverage for your situation.