8 Changes to Medicare in 2025 That May Impact You

More than 65 million Americans receive Medicare, a healthcare program for those over 65 funded by the federal government. In 2025, there will be a few changes impacting enrollees.

Every year, there are a few changes to the Medicare program, typically in terms of fees and deductibles that beneficiaries pay out of pocket. The government discloses the changes in the months leading up to enrollment to help you make educated decisions for the year ahead.

With open enrollment underway for 2025, here’s what you need to know.

1. Open Enrollment Period

The open enrollment period for Medicare is from October 15 to December 7. During this time, beneficiaries can change their plan, such as signing up for Part D, switching Part D plans, and even opting for Medicare Advantage.

The changes will not go into effect until January 1, 2025. Any changes to plan coverages and eligibility are usually sent ahead of enrollment.

2. New Optional Payment Plan

For those on a budget, paying all of the costs upfront for healthcare can be financially challenging. Beginning in 2025, beneficiaries will be able to spread copays for treatment and prescriptions across a few months instead of paying it all upfront.

The specific details aren’t yet available, but if they are spread out across the year, they will not exceed $167 per month, as there is an out-of-pocket cap. Speaking of which…

3. Cap Limit Imposed for Part D Expenses

In 2025, Medicare beneficiaries will be limited to $2,000 out of pocket. This counts for both deductibles and coinsurance. The Part D deductible is $590, which means you’ll pay all prescription costs until you hit that sum. Then, you’ll pay 25% coinsurance until you reach $2,000 out of pocket.

However, there’s a notable exception, which could impact some Medicare users significantly. Those who receive outpatient treatment such as chemotherapy through Part B will not see these savings. It’s only applicable to Part D. Beyond 2025, the $2,000 limit is likely to increase.

4. Medicare Advantage Plan Changes

This applies only to Medicare Advantage plans that include prescription drug programs. While none of these changes are set in stone, those who use Advantage may see higher premiums and/or reduced coverage.

Additionally, there’s a possibility that changes to copay costs and coverage areas—for example, doctors exiting the program—could be forthcoming. Dental coverage could also be reduced. If you are a Medicare Advantage beneficiary, make sure you read all documents and understand the changes to your specific coverage.

5. Changes to Premiums

Each year, the government adjusts Part B premiums. In 2025, those costs are likely to increase.

The increases affect both Part B and standalone Part D plans. As of the time of writing, the exact costs have not yet been released. Demonstrations, however, announced by the Centers for Medicare Services this July, have temporarily limited year-over-year increases to just $35.

6. Transparency About Your Use

In 2025, Medicare Advantage enrollees will receive a letter notifying them of “Unused Supplemental Benefits.” The goal is to get the beneficiaries to use those services and prevent unused funds from rolling back into the agency and rather go toward their intended use.

These supplemental benefits may vary but often include dental, vision, fitness, and hearing services.

7. Potentially Increased Access to Mental Health Care

Millions of Americans suffer from mental health issues, but there’s a problem with a lack of access to care through Medicare programs. That is likely to change in 2025 as the program is opening up to more healthcare providers.

Marriage and family therapists, addiction counselors, and mental health counselors can all enroll.

8. Increased Access to Biosimilar Prescriptions

Biosimilar prescriptions are those extremely similar to biologic drugs approved by the FDA. They tend to be lower cost, but should not be confused with generics.

Access to these drugs could improve overall healthcare, particularly if there are shortages throughout the year. Many on the market now treat symptoms such as arthritis, chronic skin conditions (think eczema and psoriasis), and diabetes.