top of page
Karen Vachon

Tips for Managing Changes to Medicare


The Vachon Agency can be reached at 207-544-4119


The Inflation Reduction Act brings big changes to Medicare plans starting January 2025.  Change isn’t easy.   Knowledge is key.  


Everyone on Medicare will be impacted.  Policy holders of PDP (Prescription Drug Plans), MAPD (Medicare Advantage Plans), and Medigap Supplement plans, take note.    


Until 2024, Medicare prescription drug plans had no maximum out of pocket caps.  In 2024 drug  costs for formulary medications capped at $8,000.  This meant that once a beneficiary spent $8,000 on  medications, their costs went to $0 cost until the end of the year-  providing relief for people with expensive medications.  


New – in 2025, prescription medication costs will be capped at $2,000.  So far, so good!  Additionally: 

  • CDC recommended vaccines will be $0 cost to patients.

  • Covered insulin will be capped at $35/month.

  • A New Program called  “Smoothing”, Medicare Prescription Payment Program, or MP3, offers Medicare beneficiaries the ability  to spread out payments on expensive medications throughout the year.


All good things have a cost.  Here’s the bad news:


  • PDP (Prescription Drug Plans) will see Increases in premium and higher deductibles.  The average monthly premium cost is expected to increase significantly. 

  • MAPD (Medicare Advantage Plans) will see increases in co-pays, coinsurances, provider network changes, formularies, and deductibles.  Additionally, plans that had $0 premium, may have a premium in 2025.

  • Medigap (Medicare Supplement Plans) policy holders will see a 12% - 15% increase in their monthly premiums.


These changes will cause confusion, panic, and upheaval for Medicare beneficiaries.  Here are some helpful tips:


Read your ANOC (Annual Notice of Change)  carefully!   The ANOC is mailed to beneficiaries in late September – in advance of the AEP (Annual Election Period October 15-December 7th).  The ANOC informs beneficiaries what is changing in their plan in the new year.  While it may be dry reading, Medicare beneficiaries should be vigilant in reading this notice – especially this year.  It is estimated that 90% of Medicare beneficiaries will receive a “negative ANOC” which means, your plan will be changing coverage and benefits in a negative way.


Know your enrollment periods:

AEP (Annual Enrollment Period)  -  October 15th – December 7th.  During this period Medicare beneficiaries can change their plan for the upcoming year, starting 1/1/2025.


OEP (Open Enrollment Period) – January 1 – March 31st.  During this period, Medicare beneficiaries can make a one-time change from one Medicare Advantage plan to another; or from Medicare Advantage plan back to  Original Medicare and enroll in a stand-alone Prescription Drug Plan.  Important to note: People who have a stand-alone prescription drug plan CANNOT change from one stand-along prescription drug plan to another stand-alone prescription drug plan during the OEP.


Important things Medicare beneficiaries should consider:

Most Medicare beneficiaries either have a Medicare Advantage Plan or a Medigap plan plus a stand-alone prescription drug plan.  Based on what you have, here’s what you should consider:

Medicare Advantage Plan (MAPD) beneficiaries should check:

  1. Are your doctors and medical facilities still in network?

  2. Are your medications in the plan formulary?

  3. Have you been happy with your current plan?


Medigap policy holders with a stand-alone prescription drug plan should consider:

  1. Can I afford the premium increase in my Medigap policy?

  2. Are my prescriptions in formulary in my current PDP plan?

  

Once MAPD beneficiaries have reviewed the ANOC, confirmed medications and doctors are in formulary and network, and have been happy with their current insurance carrier – consider the old adage: If it isn’t broke, don’t fix it.  Their plan will automatically roll over – they don’t have to do anything!  


MAPD beneficiaries unhappy with their plan, can switch plans,  in the AEP and OEP.  The OEP is a best kept secret –  this enrollment gets you out of the rush and chaos of AEP, and agents can provide more quality time helping you.


Medigap policy holders concerned about the affordability of rising premiums, may consider:

  1. Switching to a Medicare Advantage plan (This switching can be done in the AEP period.)

  2. Switch from a Medigap Plan F or G to a Medigap Plan N.  (Switching can take place anytime!)


Stand-along Prescription Drug plan members: It cannot be over emphasized:  Switching PDP plans can only be done in the AEP.  Read your ANOC carefully!


Change isn’t easy.  Don’t panic. Avoid 1-800 phone lines.  Don’t click  links on the internet and emails.  It costs nothing to have a trusted, local Maine insurance agent.  


Not affiliated with or endorsed by Medicare or any Government agency



Comments


bottom of page