By Christian Regalado
If you have a Medicare Advantage or PDP plan, by the end of September you should receive your Annual Notice of Change which highlights plan changes for next year. Most years there are only minor adjustments, but not this time. The Inflation Reduction Act mandates that insurance companies must make changes, primarily regarding Medicare prescription drug coverage.
The good news is that the annual out-of-pocket maximum for prescription drugs will be reduced to $2,000 from $8,000, and there is a new payment plan option that allows you to spread those payments out over the entire year. So for example, if you need a particularly high-cost drug, instead of paying $2000 right away you can request to pay about $167 each month, and you won’t spend any more money for prescriptions that year. The bad news is the insurance companies will employ tactics to make up for their profit losses, likely through increasing premiums for PDP plans and reducing benefits in most Advantage plans by doing things like lowering dental benefits and/or increasing copays.
Brokers won’t see the 2025 plans until late September, and we can’t discuss them with clients until October 1. What you can do ahead of time is provide your broker with a list of prescriptions you’re taking which can be put into a database. When the new plans come out, your broker will compare your prescription costs across plans.
In the past, the great majority of Medicare clients stayed on their current plan without making any changes. Next year, it’s estimated that up to 80% of seniors with Medicare plans will consider other options because of changes in their current plan. We can help!
AEP, or the annual enrollment period for those on Medicare Advantage and PDP plans, will start on October 15 and end on December 7. This is your opportunity to make a change to your Advantage or PDP plan for 2025. Because of the many changes, I expect carriers and brokers will be very busy just answering questions and changing plans for clients, so make an appointment with your broker starting after October 15.
It is also a big opportunity for 800 call centers to advertise that they have a better plan for you. Remember they are motivated to have you CHANGE plans. That is the only way they make money. A change may be necessary, but you may also be good right where you are. Get an unbiased opinion from a certified broker that only wants you to have the best plan that fits your needs.
If you are aging into Medicare by turning 65 or retiring and coming off your group plan, your first step should be enrolling in Medicare which you can do online or by visiting a social security office.
Should you need help, give us a call. Our services are free and as independent brokers, our job is to help you find the plan that works best for you. I am certified with many different insurance carriers, and I am happy to answer your questions and assist any way that I can.
Email me at christian@evergreenhealthins.com or call (850) 687-7606.
Author: Sowal Editor
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