What you need to know —

The Inflation Reduction Act is the change agent that is causing a stir for 2025. The impact is that Part D coverage is being paid by a smaller amount from Medicare, leaving Insurance companies responsible for more of the burden. Due to that, the plans for 2025 have many changes and most often more limited benefits. The changes are on both Part D -Drug only plans and on Medicare Advantage plans (Part C) with or without Part D included. 

Don’t be fooled about the $2000 cap on out-of-pocket drug costs. Yes, it is a benefit to some, however the caveat is your plan must cover ALL your drugs, by having them on the formulary. If your medicine is no longer on the formulary maybe there is a different plan to switch to so it is covered, or perhaps you will need to check with your doctor about a change to a drug that is on the formulary. The formulary is the specific list of drugs covered on a plan. Plans have changes to formularies each year, but this year they are more significant. In addition, the way the plan attributes your copayments and coinsurance to your out of pocket called a True Out of Pocket (TROOP) is complicated. Since the insurance company is absorbing more drug costs, other benefits on a Medicare Advantage plans have suffered and benefits you might have enjoyed in the past may be reduced or no longer be included for 2025.

Please check your coverage this year. If you have loved ones or friends that have not had a review of coverage, this year is important to do that in the annual enrollment (10/15-12/7) to avoid benefit and cost surprises for 2025.

Not on Medicare? Need regular health insurance and help with Connect for Health? – WE DO THAT TOO! Enrollment begins Nov 1, for 2025.

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We do not offer every plan available in your area. Currently we represent 10 organizations which offer 106 products in your area.Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program(SHIP) to get information on all of your options.