Medicare beneficiaries will soon have the opportunity to review their coverage options during the annual open enrollment period from October 15 to December 7. However, a new analysis from KFF reveals that the majority of seniors, approximately 69%, did not compare their current coverage with other Medicare plans during the previous enrollment period for 2022 coverage. This lack of plan comparison is surprising given the extensive marketing and advertising efforts by private health insurance companies offering Medicare coverage.
These companies, including major players like Aetna, Cigna, Humana, and UnitedHealthcare, will unveil their Medicare Advantage benefit options for the upcoming year. Medicare Advantage plans, which are chosen by more than half of all Medicare beneficiaries, provide traditional Medicare coverage along with additional benefits and services. Despite the premise that beneficiaries will compare plans to select the best coverage for their needs, the KFF analysis suggests that this is not happening in practice.
Among Medicare Advantage enrollees, 43% did not review their current plan’s coverage for potential changes in premiums or out-of-pocket costs, while 44% did not check for changes in the types of treatments, drugs, and services that would be covered in the following year. This trend indicates a possible disconnect between the availability of Medicare plan options and the efforts made by beneficiaries to ensure they are enrolled in the most suitable plan. As the open enrollment period approaches, it is crucial for Medicare beneficiaries to carefully review their coverage options and consider any changes in their current plans to make informed decisions about their healthcare coverage for the upcoming year.
The Centers for Medicare & Medicaid Services (CMS) announced that average monthly premiums for Medicare Part D and Medicare Advantage plans are expected to decrease in 2025. The average monthly premium for a stand-alone Part D prescription plan is projected to be $40, a decline of $1.63 from the previous year. Similarly, average Medicare Advantage monthly premiums are expected to decrease by $1.23 to $17 in 2025.
Medicare Advantage members must be enrolled in Parts A and B of Medicare, with Part A being free for those who have worked and paid for at least 40 quarters. CMS officials say that about 60 percent of Medicare Advantage enrollees who stay in their current plan will have no MA premium next year, and more than 80 percent will have the same or lower premiums if they remain with the same plan. Despite the average premium decrease, some plans may still experience increases.
Plans can also make changes to their coverage and costs, making it important for beneficiaries to compare plans during the open enrollment period from October 15 to December 7. One significant change taking effect next year is the cap on out-of-pocket spending for covered drugs in Part D plans, which will be much lower than what someone with high medication costs currently pays. However, plans can also remove or add medications to their drug lists and increase deductibles and copayments before reaching the cap.
The lower average premiums for next year may be partly due to a monetary incentive provided by CMS to insurers to keep enrollees’ monthly bills stable. Almost all companies agreed to participate in this program, which is scheduled to last up to three years. Medicare beneficiaries will have access to an average of 15 stand-alone Part D plans and about 34 Medicare Advantage plans with prescription drug coverage in their area.
Any new plan selected during the open enrollment period will take effect on January 1.
few beneficiaries review Medicare plans carefully
It is essential for those with Medicare Advantage plans to pay attention to coverage for their medical needs and details of other benefits, such as copays and limits on dental care.
Even if satisfied with their current plan, beneficiaries should review the annual notice of change to identify any differences for 2025. This document should be received from the plan by the end of September. The Medicare Plan Finder is now available for comparing options for all available plans in a beneficiary’s area for 2025.
CMS has released information about Medicare Part D plans for 2025, revealing that many insurers are increasing premiums for their stand-alone drug plan offerings, although not uniformly across all plans. Some major plan sponsors, such as Aetna and UnitedHealthcare, are also reducing their stand-alone prescription drug plan offerings. The total number of PDPs nationwide will decrease from 709 in 2024 to 524 in 2025.
The release of Medicare plan details has garnered more attention this year due to changes under the Inflation Reduction Act taking effect in 2025, including a new $2,000 cap on out-of-pocket drug spending for Part D enrollees and an increased share of high drug costs paid by insurers. While these changes provide enhanced financial protection for enrollees, there were concerns about potential significant premium increases, especially for stand-alone prescription drug plans. However, a comprehensive analysis suggests that premium increases for 2025 were moderated by a new initiative from the Biden-Harris administration, which capped premium increases at $35 per month, among other measures.
Observing changes for some popular plans in California shows a mixed picture:
1. The monthly premium for the most popular PDP nationwide, Wellcare Value Script, is increasing by $17 in California, from $0.40 to $17.40. 2.
Aetna’s SilverScript SmartSaver will no longer be offered nationwide in 2025, and enrollees will be switched to Aetna’s sole PDP offering, SilverScript Choice, with their monthly premium increasing from $18.60 to $53.60. However, current SilverScript Choice enrollees will see a $1.60 decrease in their premium between 2024 and 2025. 3.
Enrollees in Humana’s Value Rx Plan will see their premiums increase by $35, from $59 to $94. According to CMS, enrollees in 8 of the 16 national PDPs offered in California for 2024 will see their premiums increase by $35 if they do not switch plans in 2025, while enrollees in 6 other national PDPs for 2024 will see a premium reduction. Most Part D enrollees are not likely to face increases of this magnitude, as Medicare Advantage plans can use rebate dollars from the federal government to reduce premiums for prescription drug coverage.
CMS reports that Medicare Advantage drug plan premiums for 2025 are holding steadier compared to stand-alone drug plans, with many charging zero premium as in previous years. Changes in plan availability and substantial premium increases for some popular stand-alone drug plans are likely to bring about significant enrollment shifts during this year’s open enrollment period, more so than in previous years when plan availability and premium changes were more modest. These premium increases for PDPs may also lead to more enrollees switching from traditional Medicare to Medicare Advantage drug plans, accelerating growth in the Medicare Advantage market.
- Forbes.”As Medicare Open Enrollment Approaches, Seniors Don’t Study Options”.
- AARP.”Premiums for Medicare Drug Plans Will Be Less Next Year, Feds Say”.
- KFF.”Medicare Part D Premiums Are Increasing for Many But Not All Stand-Alone Plans in 2025, Reflecting Effects of New Premium Stabilization Demonstration”.