Future proof your healthcare by understanding the 2025 Medicare changes. This is not the year to throw your Medicare book out when it comes in the mail. There are many changes coming, and many are good for Medicare recipients however it may impact other benefits. Let’s dive in and take a look at why during this open enrollment period is a good time may be to review your benefits and discuss changes with your advisor.
Key Changes Explained
1. Introduction of Value-Based Care
The new value-based care model aims to enhance the quality of healthcare services for Medicare beneficiaries. This model shifts the focus from the quantity of services provided to the quality of care received. Expect improved health outcomes and better care experiences as healthcare providers prioritize patient health and satisfaction over sheer volume.
2. Expansion of Telehealth Services
The expansion of telehealth services is a game-changer, especially for those living in rural areas. By increasing accessibility, Medicare is bridging the gap for individuals who previously had limited healthcare options. This means fewer unnecessary in-person visits and more convenient access to medical professionals from the comfort of your home.
3. Lower Prescription Drug Costs
For Medicare Part D beneficiaries, the implementation of policies to reduce prescription drug costs promises financial relief. With medications becoming more affordable, managing your health conditions will no longer be such a heavy financial burden.
A couple of things here with medications. First the $2000.00 cap on medications. Once your out-of-pocket expenses are at 2000 you will not pay any more for your medications.
As an example, for those that take medications that are more costly out of pocket such as the blood thinners Xarelto and Eliquis you will not pay more that 2000.00 per year plus you can even get on a monthly payment plan to lower monthly coastal
PRO TIP:
Your advisor is not allowed to ask you healthcare related questions. So unless you are sharing this information on your own they may not understand the best plan for you. If you have a chronic illness or on medications that normally are more costly you can discuss this with your advisor but they cannot ask you these questions. Obviously you must feel comfortable sharing these details. Again we don’t want you having any surprises.
Your advisor can ask about lifestyle, or how important is it to keep your same doctor, or do you travel away from home for long periods of time in the winter months? These are also important things to discuss when choosing your coverage. Lastly, your budget will play a role in choosing your plan. Your advisor can also help you find a plan that meets your budget.
Another medication change is the availability of biosimilar medications that are approved by the FDA and are similar to a “generic” biologic drug. This will also help to reduce costs making these drugs more affordable. Some people might now be able to use these drugs due to the cost. Now they may be within their reach. Here are some examples.
Here are some examples of biosimilar drugs and their uses:
- Zarxio (filgrastim-sndz): This is a biosimilar to Neupogen and is used to boost white blood cell counts in patients undergoing chemotherapy, helping to reduce the risk of infection.
- Inflectra (infliximab-dyyb): A biosimilar to Remicade, it is used to treat autoimmune conditions such as rheumatoid arthritis, Crohn’s disease, and ulcerative colitis.
- Truxima (rituximab-abbs): This biosimilar to Rituxan is used for treating certain types of cancer, including non-Hodgkin’s lymphoma and chronic lymphocytic leukemia, as well as autoimmune diseases like rheumatoid arthritis.
- Mvasi (bevacizumab-awwb): A biosimilar to Avastin, it is used in the treatment of various cancers, including colorectal, lung, and kidney cancers.
- Basaglar (insulin glargine): Although technically a follow-on biologic rather than a biosimilar, it is similar to Lantus and is used to control blood sugar levels in people with diabetes.
- Erelzi (etanercept-szzs): A biosimilar to Enbrel, used for treating autoimmune conditions like rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.
- Amjevita (adalimumab-atto): A biosimilar to Humira, it is used for a variety of inflammatory conditions, including rheumatoid arthritis, Crohn’s disease, and psoriasis.
- Retacrit (epoetin alfa-epbx): A biosimilar to Epogen and Procrit, used to treat anemia caused by chronic kidney disease, chemotherapy, or certain medications.
- Fulphila (pegfilgrastim-jmdb): A biosimilar to Neulasta, it helps reduce the risk of infection in patients undergoing chemotherapy by boosting white blood cell production.
- Ontruzant (trastuzumab-dttb): A biosimilar to Herceptin, used in the treatment of HER2-positive breast cancer and gastric cancer.
4. Updates to Medicare Advantage Plans
With these changes you may see changes in your Medicare Advantage Plan benefits. Some insurance companies are trying to find ways to make up their cost of the cap on medications and other Medicare mandated changes.
This is why it is a very good time to examine the changes for your advantage plan for 2025 so you are not caught by any surprises by letting your plan “ride” for 2025. It is a good time to review your options with your advisor. Open enrollment began on October 15 thru December 7, 2024.
Let’s Recap the Medicare Changes:
For 2025, Medicare is introducing several significant changes:
- Part D Drug Costs: A $2,000 cap on out-of-pocket expenses for Part D drugs will be implemented, eliminating the “donut hole.” Once this cap is reached, beneficiaries will not have to pay copays or coinsurance for the rest of the year.
- Payment Plans: Beneficiaries can opt for a payment plan to spread out drug costs over the year, although this won’t reduce the total amount spent.
- Medicare Advantage Plans: These plans may see changes in premiums, coverage, and formularies due to the new cost cap and limited government payment increases.
- Mental Health Access: More mental health professionals will be able to enroll as Medicare providers, expanding access to services.
- Biosimilar Drugs: There will be increased availability of lower-cost biosimilar drugs.
Why It Matters
Staying informed and prepared for these changes is vital to maintaining quality healthcare access. By understanding what’s coming, you can make informed decisions that ensure you and your family are covered. These changes are designed to improve the healthcare landscape, but being proactive is key to fully benefiting from them.
Call to Action
- Stay Informed: Regularly check official Medicare resources for updates and clarifications on the 2025 changes.
- Plan Ahead: Consider the implications of these changes if you or your family members are approaching the age of eligibility, and start planning accordingly.
- Engage with Your Provider: Discuss the potential impact of these changes on your healthcare with your doctor or healthcare provider to ensure you’re well-prepared.
- Explore All Options: Research and compare different Medicare plans, including Advantage and Part D coverage, to find the best fit for your specific healthcare needs.
- Schedule a time to meet with your advisor to review the new Medicare changes.
Conclusion
The 2025 Medicare changes bring both opportunities and challenges, but by being informed and proactive, you can ensure a smooth transition. Remember, your health and well-being are paramount, and taking the time to understand these changes will empower you to make the best decisions for your future. Stay engaged, explore your options, and ensure your healthcare is future-proofed.
This is always a complex situation for many of our seniors. Please don’t hesitate to reach out to your insurance advisor to determine what is the best Medicare option for you.
Thanks again for taking the time to stop by and spend a bit of time with us on such an important topic. We will see you back here soon. Don’t hesitate to reach out and share a comment or question. For assistance in figuring out the questions to ask or to discuss your unique situation before you meet with your advisor we are here. We offer a free 30-minute consultation. You can book yours here.
Take care and we will see you back here soon,
Pam and Linda
Your Nurse Advocates
“Compassionate Care for Aging Parents, Peace of Mind for Adult Children.”
Resources:
Your Nurse Advocate Consulting Free Resources:
https://www.medicare.gov/plan-compare/?os=.&ref=app#/?year=2025&lang=en
https://www.fda.gov/drugs/biosimilars/biosimilars-basics-patients
