The Medicare annual enrollment period begins on Oct. 15, and seniors everywhere will soon have an important decision to make. Unless they qualify for a special enrollment period, this will be their only opportunity to select a plan for 2025. That choice has a huge effect on their annual out-of-pocket retirement healthcare costs, so it's crucial to understand what's covered and what's not.
You might think you know this already if you have been on Medicare for a while. But the program changes every year. Some of these six changes are for the better, and others could make your life much harder next year if you're unprepared.
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1. A $2,000 cap on prescription drug costs
One of the Biden Administration's biggest victories has been a new law that caps out-of-pocket prescription drug costs at $2,000 for Medicare Part D plans. The $2,000 limit includes funds that you and other people or entities make on your behalf.
This includes Medicare's Extra Help program for low-income seniors. Any money that program pays for you counts toward your $2,000 out-of-pocket limit. After you meet this limit, you won't have any Part D co-payments for the rest of the calendar year. But this doesn't apply to medications not covered by your Part D plan.
2. A new option for a prescription payment plan
Next year will also bring a new prescription payment plan that lets seniors on Medicare spread their medication costs over the entire year rather than paying them as they occur. This won't reduce how much you owe, but it can make your payments easier to manage.
All Part D plans will offer this option for free, but it's voluntary. If you opt to participate, you must continue to pay your Part D premium throughout the year.
You won't get a bill from the pharmacy. Instead, you'll get another bill from your Part D plan administrator for this cost. You can learn more about this payment option on Medicare's website or by checking with your Part D plan provider.
3. Limits on telehealth access
Medicare beneficiaries currently have access to telehealth services from wherever they are. But this will end on Jan. 1, 2025. At that point, Medicare won't cover most telehealth services unless you're in an office or medical facility in a rural area.
There are exceptions for the following telehealth services:
- Monthly End-Stage Renal Disease visits for home dialysis
- Service for diagnosis, evaluation, or treatment of symptoms of an acute stroke wherever you are
- Services to treat a substance-use disorder or co-occurring mental health disorder; or for the diagnosis, evaluation, or treatment of a mental health disorder, including at-home treatment
- Behavioral health services in your home
- Diabetes self-management training
- Medical nutrition therapy
When using telehealth, you will still be responsible for paying your Part B premium and any applicable co-pays.
4. Expanded health-risk assessments at Wellness visits
Preventive annual Wellness visits aren't new to Medicare, but their services will expand in 2025. Your healthcare provider will now use questionnaires to understand your social needs and refer you to appropriate services and support.
Doctors will also begin screening for signs of dementia, including Alzheimer's, as well as substance-use disorders. If you exhibit symptoms of any of these conditions, they can help you find appropriate treatment options.
5. New caregiver training resources
Seniors on Medicare who receive care from a family member will be able to use the program to cover the cost of their caregiver's training beginning in 2025. Your healthcare provider must determine that caregiver training is appropriate, though you don't have to be present at the training.
Medicare will cover both individual and group training sessions as long as they're focused on your health and treatment goals. It's also rolling out a new pilot training program to help those living with dementia as well as their family and unpaid caregivers.
6. A new benefit program for Postal Service employees and family members
Beginning Jan. 1, 2025, U.S. Postal Service employees, retirees, and their families will get healthcare coverage under the new Postal Service Health Benefits program instead of the usual Federal Employee Health Benefits program.
This plan is expected to offer savings to many of its enrollees who are also enrolled in Medicare. You can learn more about this new program on the U.S. Office of Personnel Management website.
If you have any questions about these changes, contact Medicare or your plan provider to clarify. It's best to act before the end of the annual enrollment period -- Dec. 7, 2024 -- especially if you're considering changing your coverage for next year.
