What do Medicare Advantage plans, also known as Part C, have in store for 2025?
Medicare Advantage plans are on annual contracts and because of this things change year to year. There can be changes in the premiums, networks, benefits and more. In this article we’ll look at some of the changes you may expect to be seeing.
Some of the changes will vary by region, but here are some trends and updates that we are seeing for Part C plans this year.
Lower Average Premiums
On average, many Medicare Advantage plans have lower monthly premiums. This can make it easier to find an affordable plan that meets your needs. It is still essential to understand the benefits and any limitations a plan may have, so you won't want to act on premium costs alone. With the right education, you can explore all available options to select the best coverage at the most cost-effective price.
Network Changes
Some Medicare Advantage plans may have network changes. This is a common occurrence among advantage plans, which are on annual contracts. Each year the carrier has to contract with the various clinics, hospitals and providers to produce the network available to that Medicare Advantage plan. At times, these changes are significant where large and popular clinic systems are no longer in-network with a particular insurance carrier; other times, the changes are for independent clinics or for only specific practicing doctors. Some plans allow you to utilize out of network providers for a reasonable cost. However, and of concern, out of network providers can refuse service to you. If you are wondering if your doctor is still in-network with your plan for 2025, reach out to our team for assistance.
Part D Medicare Changes
For the first time in Medicare history, Part D medication costs will be capped at $2,000 out of your pocket annually. This applies to both stand-alone Part D prescription plans (PDPs) and Medicare Advantage Plans with Part D coverage (MAPDs). This important change is intended to make medications more affordable and accessible for all Medicare enrollees, offering peace of mind and financial relief to those who need it most.
Find out more about the Medicare Part D Changes for 2025
Star Ratings
Each year Medicare plans, Advantage and Part D prescriptions plans are assigned a star rating. As explained in this Star Rating article from CMS, "changes in Star Ratings year-over-year are normal and expected and vary by measure. The Star Ratings are intended to capture a contract’s performance during the measurement period and some contracts perform better or worse in different years".
Medicare Star Ratings are based on several factors. Some of these include:
- Quality of care
- Member experience and customer service
- Managing chronic conditions
- Plan responsiveness and care
- Member complaints
- Disenrollment
- and more
Why is this important? Not only does a high star rating indicate that enrollees have been satisfied with their Medicare coverage through this particular plan, a 5-star rated plan is available for enrollment year round. Therefore, if someone is not pleased with their coverage, they can enroll into a 5-star plan at any time in the calendar year without another qualifying enrollment reason.
Find out more about why Medicare Star Ratings Matter
Medicare Advantage Mid-Year Enrollee Notification
Starting in 2025, CMS will require Medicare Advantage plans to provide each enrollee with a personalized mid-year notification that outlines any supplemental benefits that haven't been utilized.
The purpose of the statement is to help plan enrollees better understand and take advantage of the benefits available to them. Although over 50% of Medicare beneficiaries are enrolled in Medicare Advantage plans that provide many additional benefits, oftentimes, these go unused because they were not properly informed that they have the benefits or how to use them. The mid-year notification, which will be sent out between June 30th - July 31st annually, is intended to help Medicare beneficiaries get the most out of their plan.
Does Your Medicare Advantage Plan Offer Extra Benefits?
Medicare Advantage OEP
If you missed the annual election period (Oct 15th - Dec 7th) or made a change to your Medicare Advantage plan that you are not satisfied with, you have another opportunity in the first quarter of the calendar year to make a change. During the Medicare Advantage Open Enrollment Period (MA OEP), which occurs yearly from January 1 to March 31, those enrolled in a Medicare Advantage (MA) plan have the option to elect a different plan, or disenroll from MA and sign up for Medicare, with or without Part D.
Find out More about Medicare Election Periods
If you have any questions about your Medicare coverage or Medicare Advantage plan, our experienced team of licensed agents can help. Reach out to us today.
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