A new year often means adjusting to a new health insurance plan with a different set of benefits and costs. Those on Medicare aren't exempt from this. Original Medicare's cost and coverage change annually. This affects how much you pay and the type of supplementary insurance you may want.
Ideally, you reviewed these changes during the annual enrollment period that ran from Oct. 15, 2024 to Dec. 7, 2024. But if not, here are the major updates you ought to know as we head deeper into 2025.
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1. Cost increases for Parts A and B
Original Medicare's premiums and deductibles went up in 2025. The Part A annual deductible increased from $1,632 to $1,676, and the Part B annual deductible rose from $240 to $257.
Most seniors don't pay a premium for Part A, but they do for Part B. The standard Part B monthly premium rose from $174.70 in 2024 to $185.00 in 2025. However, some high earners could pay as much as $628.90 per month for this coverage. Keep in mind, both parts of Original Medicare also include copays, which could further increase your out-of-pocket costs.
2. $2,000 cap on out-of-pocket prescription drug costs
In happier news, President Joe Biden passed a law limiting out-of-pocket prescription drug costs to just $2,000 annually for Medicare recipients who are enrolled in Part D prescription drug plans. The $2,000 cap includes money that you pay toward your own medications, as well as money that anyone else, including Medicare's Extra Help program, pays on your behalf.
Once you've met your cap for the year, you won't have any additional copays for your medications for the rest of 2025. This only applies to drugs that are covered under your Medicare Part D plan.
3. Reduced access to telehealth services
In 2024, seniors on Medicare could access telehealth services from anywhere. But in 2025, you generally must be in an office or medical facility located in a rural area to access most telehealth services.
There are some exceptions to this rule for the following:
- Monthly End-Stage Renal Disease (ESRD) visits for home dialysis
- Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke
- Services to treat a substance use disorder or a co-occurring mental health disorder or for the diagnosis, evaluation, or treatment of a mental health disorder
- Behavioral health services
- Diabetes self-management training
- Medical nutrition therapy
You will still be able to use telehealth services for the above reasons from anywhere, even your own home.
4. More resources for caregivers
Beginning in 2025, Medicare will cover the cost of training for caregivers if your healthcare provider determines training is appropriate. Medicare will cover the cost of individual or group training, even if you are not present. The only rules are that your treatment requires a caregiver and the training focuses on teaching skills suited to your needs.
The Medicare Part B deductible and 20% copay applies to these training sessions as they would any other Part B expense.
5. New program for Postal Service employees and retirees
As of Jan. 1, current and former U.S. Postal Service employees are no longer covered under the Federal Employee Health Benefits Program. Instead, they're covered through a new program known as the Postal Service Health Benefits Program.
Affected seniors should have received an insurance card in the mail, as well as details about the new program and what it covers. If you have any questions about this, particularly regarding how the new program works with Medicare coverage, you can contact your plan carrier.
The above changes may not all apply to you right now, but they're worth keeping in the back of your mind anyway. If you have any questions about whether a certain treatment or drug is covered, check your plan documents or reach out to the Centers for Medicare & Medicaid Services for clarification.
