Medicare Annual Enrollment Changes: With the Medicare Open Enrollment Period for 2025 running from October 15 to December 7, it’s important for consumers to be aware of key changes in plans and pricing.
Some of the most notable changes will affect Medicare Advantage and Part D prescription drug plans.
Medicare Advantage plans will experience a significant reduction in availability, with 7% fewer options compared to previous years. Although this still represents a high number of plans, it could lead to smaller provider networks, fewer extra benefits, and potentially higher out-of-pocket costs.
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2025 Medicare Advantage Plans Trends
In 2025, the average number of Medicare Advantage plans offered in each county in the U.S. will be 34, down from 43 in 2024, according to Forbes. Additionally, there will be 6.6% fewer Medicare Advantage plans with prescription drug coverage next year, including 5.4% fewer plans from UnitedHealth Group and 2.5% fewer from Humana.
On a positive note, the average monthly premium for Medicare Advantage plans will decrease to $17.00 in 2025, down from $18.23 in 2024, as reported by the Centers for Medicare & Medicaid Services (CMS). However, some plan premiums may still increase.
Benefit options, including supplemental benefits like hearing, dental, and vision care, are expected to remain stable in 2025, according to CMS.
Providers not accepting certain Medicare Advantage plans
Even if your Medicare Advantage plan remains available in 2025, there’s a possibility that your healthcare provider may no longer participate in the plan. For example, Essentia Health announced it would no longer accept Medicare Advantage plans from Humana and UnitedHealthcare, while Sanford Health, a prominent provider in the Midwest, ended its contract with Humana Medicare Advantage.
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According to a recent survey by the Healthcare Financial Management Association (HFMA), around 16% of health systems anticipate ceasing acceptance of one or more Medicare Advantage plans in the next two years. This trend is largely due to the challenging authorization requirements and high denial rates associated with these plans.
If you’re enrolled in a Medicare Advantage plan, your medical expenses are typically covered only when you use in-network providers. Out-of-network care will likely come with significant out-of-pocket costs. Therefore, it’s crucial to review your plan during Open Enrollment to confirm that your doctors, hospitals, and other healthcare providers are still included in the network for 2025.
Medicare Part D 2025 Changes
An important change for Medicare Part D in 2025 is the elimination of the “donut hole,” which previously led to high out-of-pocket prescription drug costs. Thanks to the Inflation Reduction Act, annual drug expenses will now be capped at $2,000, a major improvement from the former $8,000 threshold. This will help people who have chronic conditions or need expensive medications.
Even though Part D premiums will go up slightly to $36.78, the savings from lower drug costs should more than make up for this increase. For many people, the reduction in out-of-pocket costs for medications will be much more helpful than the small rise in premiums.
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To make sure you’re getting the best deal, use Medicare’s plan finder tool to compare plans and check if your medications are covered. While there will be fewer stand-alone Part D plans available (a 26% decrease), each state will still offer at least 12 options.
It’s important to pay attention to which plans cover your medications and which pharmacies are included. If you need more coverage, Medicare Advantage plans that include drug coverage might be a good choice.
Medicare will also provide more help for mental health needs in 2025. This includes coverage for counseling, mental health medications, and financial help for dementia care. There will also be new resources to help older adults live at home longer. Families can use these services for extra support.
