Changes Coming for Medicare Part D in 2025

There's quite a bit of buzz around the changes for 2025 Medicare Part D plans and Advantage plans. I've already had multiple inquiries, and the talk is that this year will be a big one for lots of switching.

Do you need to worry? I say no, but you do want to stay aware.

Important changes coming to Part D plans:

1. As part of the Inflation Reduction Act, Part D enrollees in 2025 will have a maximum out-of-pocket (MOOP) expense of $2,000 for the calender year, which should provide great relief to people with high prescrition drug costs. The $2,000 cap will be indexed to rise with inflation in the coming years.

2. Another provision in the Inflation Reduction Act, called the Medicare Prescription Payment Plan (MPPP), will allow for an alternate payment structure for enrolles to pay for their prescrition drugs. Referred to commonly as “smoothing,” the MPPP will allow people enrolled in a Part D plan to have the option of spreading their out-of-pocket Part D costs over the calendar year rather than paying directly at the pharmacy counter. When someone opts into the MPPP, their Part D provider will pay the beneficiary’s deductible, coinsurance, and/or copay, depending on their plan details directly to the pharmacy, then the provider will send a monthly bill to the beneficiary. It is important to note that the MPPP will not reduce or increase a person’s Part D cost-sharing obligations–it only spreads them out so that they are hopefully easier to pay.

The Open Enrollment Period for 2025 will run from October 15 to December 7. During this period, Medicare enrollees can:

• Join, drop, or switch to another Medicare Advantage Plan (or add or drop a Part D Precription Drug Plan).

• Switch from Original Medicare to a Medicare Advantage Plan or from a Medicare Advantage Plan to Original Medicare.

• Join, drop, or switch to another Medicare drug plan if you’re in Original Medicare.

Have questions? Please let me know. Medicare is confusing, so let me help you make decisions that are best for your needs.

What to Know about Health Insurance when Moving to Another State

Let’s say you move from California to Tennessee, does your insurance move with you, or do you need new insurance?

Most individual health insurance is not transferable from one US state to another. Therefore, if you move to a new state, a part of the moving process needs to be obtaining health insurance in your new state of residence. This holds true whether you have individual/family coverage or Medicare (including Supplements, Advantage plans, and Prescription Drug plans).

Let’s explore both types of insurance.

It You’re Under 65 and Moving from One State to Another - Health Insurance for Individuals and Families

Employer-sponsored Plans

If your employer transfers you to another state and you’re covered by their health plan, you probably don’t need to worry because you can most likely stay on the same plan as long as the employer-sponsored plan has an adequate network in the new state. If the plan doesn’t have an adequate network, the employer will likely find you a new, accommodating plan in the new state.

However, if you have coverage through a non-Marketplace individual or family plan, you will need to check with your insurance plan to see if they have a good network in your new state and change plans if necessary.

Marketplace Plans

If you have a plan through the Marketplace, your move will require some action because Marketplace plans don’t transfer from one state to another.

First, report your move to the Marketplace as soon as possible in order to avoid a gap in coverage. For most states (including Tennessee), this can be done by going to https://www.healthcare.gov/login and entering your new state or residence. If your new state appears on this list, it means they have their own website where you’ll apply.

Normally, enrolling through the Marketplace can only be done during the annual Open Enrollment Period at the end of the year, but a move to a new state is known as a “qualifying life event,” which makes you eligible for a Special Enrollment Period (SEP). The special enrollment period allows you 60 days from the time of your move to enroll in a qualified health insurance plan through the federal marketplace, your new state’s exchange, or elsewhere. It is important to note that the SEP onlys exists if you had credible coverage in the state you left (defined as having minimum essential coverage for at least one of the 60 days preceding the move).

Medicare Coverage when Moving from One State to Another

Necessary actions for Medicare coverage when moving to a new state vary depending on the type of coverage.

Original Medicare

If you only have Original Medicare (Parts A and B), your benefits and coverage won’t be affected since Original Medicare is a federal healthcare program. Still, you need to contact the Social Security Administration about your change of address in order to continue getting important information from them.

Medicare Advantage

Since Medicare Advantage plans are managed by private companies, any move to a new state will trigger a Special Enrollment Period, during which time you can:

• Switch to a new Medicare Advantage Plan or Medicare drug plan.

• Return to Original Medicare (if you’re in a Medicare Advantage Plan and you move outside of that plan’s service area).

It is important to note that if you don’t enroll in a new Medicare Advantage Plan during the SEP, you’ll automatically be enrolled in Original Medicare once you’re disenrolled from your old Medicare Advantage Plan.

There are certain windows during which you can report your move. If you tell your plan before you move, the SEP begins the month before the month you move and continues for 60 days after you move. If you tell your plan after you move, the SEP begins the month you tell your plan and lasts for 60 days more.

Prescription Drug Plans

Much like an Advantage plan, Medicare Part D drug plans are sold by private insurers and are specific to each state, so your move will mean you will need to enroll in a new plan.

If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move. If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.

Medicare Supplements

Since Medicare Supplements (also known as Medigap plans) are supplemental to Original Medicare and have the same carriers nationwide, in most cases you can keep your current coverage in your new state. Any provider who accepts original Medicare in your new state will accept your Medigap insurance, but make sure to inform your carrier 30 days before your move.

There are 2 exceptions:

1. If you are moving into or out of Massachusetts, Minnesota, or Wisconsin. With Medigap, there are ten standard Supplement plans available in every state, designated by letters (A, B, C, D, F, G, K, L, M, and N), but the above states offer some different options.

2. If you have a Medicare SELECT plan that limits your providers to certain hospitals; however, you would have guaranteed issue rights in this instance.

Moving will allow you the opportunity to shop for coverage from a different Medigap plan in your new state, but as always, don’t terminate your current supplement until the new one has been issued.

Why You Should Check Your Medicare Options During the Annual Enrollment Period

The Annual Enrollment Period Medicare (AEP) runs from October 15th to December 7th, and it is the time every year when Medicare beneficiaries can make changes to their current coverage. Beneficiaries can switch from traditional Medicare to an Advantage plan or vice versa, or add, switch or drop a Part D drug plan. Plans and options change every year, so it’s important to review what’s best for you.

Unfortunately, most people don’t.

According to a just released study by the Kaiser Foundation, 71% of Medicare beneficiaries neglect to review their coverage options annually. According to Kaiser, “the average Medicare beneficiaries can choose among 33 Medicare Advantage plans and 30 Part D stand-alone prescription drug plans (PDPs).”

Costs and coverages between the plans can vary significatly, and the plans themselves change every year:

• New players may enter the market.

• Plans may be dropped, added, or changed as insurance companies try to optimize their product line.

• Provider networks may change, which means your doctor may not be in network anymore.

• Drug formularies may change, which means your current plan may not include all of your prescription drugs.

• Also, your health needs may have changed since last year.

For the reasons stated above, the Centers for Medicare & Medicaid Services (CMS) recommends that beneficiaries review and compare Medicare plans each year. Medicare is complicated, and it’s hard to know if you’re choosing the option best for your needs. Feel free to contact me for an expert opinion.

Get an Online Insurance Quote

If you want to do a quick comparison yourself, you can see how your current plan compare compares to others by going here.

Medicare Annual Enrollment Period Checklist for Fall

The Annual Enrollment Period (AEP) for Medicare will begin on October 15 and last until December 7. It’s the time when a Medicare beneficiary can make changes to their current coverage.

Plans change every year, and the needs of beneficiaries also change. If you’re already enrolled with a Medicare plan, you will receive an Annual Notice of Change (ANoC) letter in September which will explain changes affecting your plan for the upcoming year.

Changes might include:

• An increase in premium

• Changes in benefits

• Changes in member doctors

• Changes in prescription drug formularies

Do you need to take action? Here’s some things to consider:

If you have a Medicare Advantage Plan - check the current list of member doctors, healthcare facilities, and medication coverage. The list gets updated every year, so you need to make sure it still works for you.

If you have an original Medicare and are interested in going to a Medicare Advantage Plan - AEP is the time when you can make the switch from one plan to another. Weigh the pros and cons and see what’s best for you. Need help? Contact me.

If you have a Part D Drug plan - you can switch from one Medicare Part D (prescription drug) plan to another during AEP. Prices, drugs covered, and pharmacies change annually, so compare plans and make sure your plan still works best for you.

What if you’re mostly happy with your plan, but want to make sure it still works for you?

First of all, good for you. It’s good you’re being proactive. You may be fine with what you have, but you might also be able to fine-tune your plan or refocus it for better coverage and cheaper prices. The Annual Enrollment Period (AEP) is the time to make changes.

Hope this helps. I represent many insurance companies, and I work hard to find the plan that works best for my clients. I also present all reasonable options so that you can be informed. If you have questions or want to review your plan, please let me know.

Medicare Annual Open Enrollment for 2020

Are you ready?

Do you have questions?

I have answers!

Initial Enrollment Period (IEP)

The best time to enroll in Medicare is when you first turn 65, unless you’re still working and have employer provided health insurance. The three months prior to the month in which you turn 65, the month of your birthday, and the three months after your birthday month is your IEP. During that time, you can enroll in Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). In most cases, if you’re already signed up for Social Security benefits at the time you turn 65, you will automatically be enrolled for Medicare parts A and B. If not, you’ll need to either sign up for Medicare online or contact Social Security.

Since COVID has come along, the Social Security offices have been closed, forcing consumers to apply for Medicare exclusively online. Do not delay doing so, if you know you want Medicare. I have been seeing some people getting surprised at how long it takes to get their enrollment completed.

Annual Enrollment Period

This is the period from October 15–December 7. I can talk to you about plans and changes beginning October 1st, but no enrollments or changes can be made until October 15th. Any changes will take effect January 1.

What changes can be made?

• You can switch from Original Medicare to Medicare Advantage, or vice versa.

• You can switch from one Medicare Advantage plan to another, or from one Medicare Part D (prescription drug) plan to another.

• You can enroll in a Medicare Part D plan if you didn’t do so when you were first eligible (a late enrollment penalty may apply.)

What about Medicare supplements?

Medicare supplements are not limited to the same enrollment periods as Part D and Medicare Advantage plans. You can change your supplement plan at any time during the year, as long as you can pass the health questions or have a guaranteed issue scenario.

Questions? Concerns?

Want a review of your plan?

Let me know. I’m based in Nashville and an appointed agent for BlueCross BlueShield, Aetna, Cigna, United Health Care, Humana, Bright Health, Oscar, AmBetter, Mutual of Omaha and more.

What is a Medicare Select Plan?

If you Google “Medicare Select plan,” you will see numerous results followed by various letters (medicare select plan f, medicare plan b, etc.). What are Medicare Select plans, and what do the letters mean?

The simple answer is that a Medicare Select plan is a Medicare Supplement (Medigap) policy that offers the same benefits as a Medicare Supplement plan, except a Select plan limits your coverage to a network of doctors and hospitals for inpatient, non-emergency stays. The various letters define the benefits offered in the plan and correspond to the same letters in the ten standardized Medicare Supplement plans. 

Advantages of a Medicare Select Plan

• Lower Premiums - premiums for Medicare Select plans can be significantly lower than the premiums for a regular Medigap plans with the same benefits (a Medicare Select Plan N versus a regular Medigap Plan N).

• Same Benefits as Medicare Supplement - plans with the same letters have the same paid benefits, but you are limited to which hospitals you may use.

Disadvantages of a Medicare Select Plan

• Not Available Everywhere - Medicare Select plans are not available in all states. Insurers only offer Medicare Select plans if they have an agreement with a network of medical providers in a given area.

• Must Remain In-Network - in most non-emergency circumstances, the insured won’t receive benefits if they use an out-of-network provider.

• Referrals Required - Medicare Select enrollees generally need to get a referral from their primary care doctor in order to see a specialist or other provider in the network.

Is a Medicare Select Plan Right for You?

You may want to consider a Medicare Select plan if:

• Your preferred healthcare provider is in the carrier’s network

• You need or want lower premiums

You may want to consider a traditional Medicare Supplement plan if:

• You want wide, national access to doctors

• Your preferred healthcare providers aren’t in the Select carrier’s network

• You travel frequently

If you have questions, feel free to contact me. As an independent broker, I have lots of options available and can help choose the best plan for you.