Medicare changes for 2025: What you need to know

By Karon Warren, The Atlanta Journal-Constitution

ATLANTA — Fall has arrived, and that means open enrollment for Medicare starts Oct. 15. There are several changes for 2024 that you should know before enrolling or updating your Medicare coverage. Even if you won’t turn 65 for a few more months, now is the time to get to know your Medicare options. Educating yourself now will help you make the right choices once you’re ready to enroll.

What’s new in Medicare

Several Medicare changes took effect in 2024 to help reduce your out-of-pocket costs. These include:

Your Medicare drug plan cannot charge a deductible or more than $35 for a one-month supply of each insulin product Part D covers.
Recommended adult vaccines are now available at no cost to you.
Medicare now covers monthly services for chronic pain treatment if you’ve been living with it for more than three months.
Medicare now covers more intensive outpatient program services for mental health care at hospitals, community mental health centers and other locations.
Medicare covers the COVID-19 vaccine and some related tests and treatments.

New changes for 2025 include:

Part D plans must limit out-of-pocket costs for covered drugs at $2,000 a year. That includes deductibles, copays and coinsurance. It’s possible your Part D coverage could have a maximum deductible of $590.
Dementia patients and their caregivers could receive more help through the Guiding an Improved Dementia Experience (GUIDE) program, which provides a 24/7 support line, a care navigator to help you find services, caregiver training, and as much as $2,500 a year for at-home, overnight or adult day care respite services.

It’s imperative to review all plans and options before making a decision. You can do a side-by-side comparison of plan coverage, costs and quality ratings at medicare.gov.

The basics of Medicare

Medicare is health insurance offered through the federal government. You must meet one of the following requirements to qualify for Medicare in order to enroll:

Be age 65 or older
Have a qualifying disability or
Have end-stage renal disease

Medicare coverage includes hospital, medical and drug coverage under three parts:

Part A, hospital insurance

Part A covers hospital stays, skilled nursing facility stays, hospice care and some home health care services. Anyone who worked and paid Medicare taxes for at least 10 years won’t pay a premium for Part A. If you have to pay a premium, the maximum monthly premium for Part A in 2024 is $505.

The deductible for Part A coverage is $1,632 for each benefit period. Hospital stays beyond 20 days require a copayment. For skilled nursery facilities, stays beyond 20 days require a copayment; once you reach 100 days, you are responsible for all costs.

Part B, medical insurance

Part B covers qualifying doctors’ visits, preventative services, medical supplies, and outpatient treatment and services. Most people pay the standard Part B premium, which is $174.70 in 2024. However, if your modified adjusted gross income was a minimum of $103,000 for an individual or $206,000 filing jointly on your tax return two years before enrolling in Medicare, your monthly premium will be higher.

For 2024, the Part B deductible is $240 per year.

Part D, prescription drug plans

Part D is your prescription drug coverage, which is purchased separately from Parts A and B, known as Original Medicare. The costs — including premiums, deductibles, copayments and coinsurance — vary by plan. If you choose a Medicare Advantage plan, or Part C, prescription drug coverage may be included. Medicare Advantage plans may also include additional coverage like dental and vision.

When do I enroll?

Medicare enrollment is available at specific times, so knowing these time frames is essential not only so you get the coverage you need but also so you avoid a penalty for not enrolling when you become eligible for Medicare.

Initial enrollment period

This period includes the three months before the month you turn 65 and the three months after the month you turn 65. For instance, if your 65th birthday is June 15, your initial enrollment period starts in March and ends in September. The exception is birthdays on the first of the month. In that case, your initial enrollment period starts four months before your 65th birthday and ends two months after you turn 65.

Your coverage will start on the first of the month depending on when you enrolled. If you enroll before your 65th birthday, coverage typically starts on the first of your birthday month. If your birthday is on the first, coverage typically starts on the first day of the prior month. If you enroll after your 65th birthday, coverage typically begins on the first day of the month after your enrollment date.

Special enrollment period

When you become eligible for Medicare at age 65, it’s important to sign up for Part A coverage to avoid a penalty. However, if you plan to keep working and have insurance through your or your spouse’s employer, you can delay enrollment in Part B coverage. While you can enroll in Part B while you have a group health plan, you can wait until that coverage ends to enroll in Part B provided you enroll within eight months after you or your spouse stop working.

If you do not sign up for Medicare during your initial enrollment period or a special enrollment period, you may have to pay a penalty.

General enrollment period

If you don’t enroll in Medicare during the initial or enrollment periods, you can enroll in the general enrollment period from Jan. 1 to March 31 each year. However, you may have to pay higher premiums due to late enrollment.

Under 65 and on disability

If you have a disability and receive monthly Social Security or Railroad Retirement Board (RRB) benefits, you will automatically receive Medicare Part A and Part B after 24 months. There is no waiting period for persons diagnosed with Amyotrophic Lateral Sclerosis, or Lou Gehrig’s disease, who receive Social Security disability benefits.

What is the difference between Medicare Advantage and a Medicare Supplement Insurance plan?

Medicare Advantage plans include Part A and Part B coverage, and are offered by private companies. Most, but not all, Medicare Advantage plans include drug coverage, or Part D. While these private companies must provide all the benefits of Parts A and B, the premiums, deductibles, copayments and coinsurance costs vary by plan. They also may offer additional coverage such as fitness programs and some hearing, vision and dental coverage.

Known as Medigap, a Medicare Supplement Insurance plan helps cover expenses not covered by Original Medicare, such as deductibles, coinsurance and copayments. They are available through private companies, and premiums vary based on the plan. Medigap plans are not available if you have a Medicare Advantage plan.

Medicare provides essential health care coverage to address your medical needs as you age. Therefore, it’s important to fully research all of your options so you get the right coverage for you. Start researching before you turn 65, so you’ll be ready when your initial enrollment period begins. The best starting point is medicare.gov, where you can create an account and start the search for health and drug plans as well as providers. You also can talk with Medicare representatives or get connected to Georgia’s State Health Insurance Assistance Program for free health insurance counseling.