The Centers for Medicare and Medicaid Services (CMS), which are the ones who administer the program, made the announcement of two important changes for 2025 that you will want to know, next year, Medicare will also drastically change the maximum amount that beneficiaries will have to contribute from their own pockets for their covered medications, here we will detail the information about these three ways that Medicare will work differently in 2025 and what they will mean for you.
The CMS are like the healthcare superheroes of America. They manage indispensable programs like Medicare for seniors and Medicaid for those in need. CMS makes sure everyone gets quality care, sets rules to keep things fair, and helps make healthcare affordable. They’re all about making sure you and your loved ones stay healthy and happy.
Strong Measures Against Agents and Brokers Selling Three Types of Medicare Policies
Today, salespeople sometimes receive incentives such as all-fee trips and sizable bonuses when they enroll new Medicare beneficiaries in private insurers’ Medicare Advantage plans (alternatives to traditional Medicare), Medigap (Supplemental Medicare), or drug plans. Part D prescriptions.
CMS hopes to eliminate sales incentives in 2025 for Medicare Advantage and Part D plans, in a statement from Senate Finance Committee Chairman Ron Wyden (D-Ore.) saying, “This announcement is a major victory for older people because it strengthens protections against high-pressure and deceptive marketing practices,”
The new action, in CMS’s 1,327-page final rule for Medicare in 2025, states that its goal is toensure that agent and broker compensation reflects only the legitimate activities required by the agents and brokers who sell those plans. This means that sellers can no longer be offered incentives to enroll people.
Additionally, the rule states, Medicare intermediaries such as third-party marketing organizations may not offer incentives that “inhibit an agent or broker’s ability to objectively evaluate and recommend the plan that best meets the needs of a potential enrollee.” .
Stay Covered: Mid-Year Notification on Unused Medicare Advantage Benefits
This measure will be applied since people sometimes do not take full advantage of their health plan benefit. This is surprising, because Medicare Advantage plans regularly advertise the coverage they provide, and traditional Medicare does not, benefits such as dental, vision, hearing and fitness, most Medicare Advantage plans provide at least one supplemental benefit.
In a study conducted by the Commonwealth Fund in February 2024, they found that three out of 10 Medicare Advantage members were not using any of the supplemental benefits during the previous year, and CMS’ statement on its 2025 rule said that “some plans have indicated that the utilization of many supplemental benefits by enrollees is low.”
The Commonwealth Fund also discovered in the year 2022 that beneficiaries were looking to choose a Medicare Advantage plan, and the most common reason cited by people for choosing such a plan instead of traditional Medicare, were supplemental benefits.
New Limit per Year, $2,000 for Out-Of-Pocket Prescription Drug Costs
In 2024, in general, when your out-of-pocket prescription spending is more than $3,300, you will qualify for Medicare “catastrophic coverage” and will not have to cover any costs for your Part D-covered drugs for the remainder of the year.
When 2025 rolls around, enrollees with Part D plans won’t have to pay more than $2,000 in out-of-pocket costs, thanks to a provision of the Inflation Reduction Act of 2022.
Out-Of-Pocket Prescription Drug Costs refer to the expenses that patients have to pay directly out of pocket for prescription drugs, after insurance benefits such as co-pay or deductible have been applied. These costs may vary depending on the type of health insurance plan the patient has and the level of coverage it offers.
In general, the costs of drugs without coverage include:
- Copays and Deductibles: Many insurance plans require patients to pay a specific amount for each prescription (copay) or reach a minimum amount before insurance begins to cover the costs (deductible).
- Non-covered drugs: Some drugs may not be included in the formulary of drugs covered by the insurance plan, which means that the patient will have to pay the full price of those drugs.
- Partial coverage: Even for covered drugs, insurance may only pay a portion of the cost, leaving the patient responsible for paying the difference.
Benefit Limits: Some insurance plans have limits on the total amount they will cover for drugs in a specific period.This may result in higher costs for the patient once that limit is reached.
