We’re about a month into the Medicare annual enrollment period, which is the only chance most people will have to select a new plan for 2025. If you haven’t reviewed your healthcare coverage yet, you have time. The annual enrollment period runs until Dec. 7, but you probably don’t want to put this off too much longer.
You’ll have an easier time figuring out which plan best suits you if you understand some of the major changes coming to Medicare in 2025. These may not all affect you now, but they’re worth keeping in mind as we move into the new year.
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1. $2,000 cap on out-of-pocket prescription drug costs
The biggest Medicare change coming next year is a $2,000 out-of-pocket cap on prescription drug spending. The $2,000 includes money you pay for your prescription medications as well as money that any other person or organization, including Medicare’s Extra Help program, pays on your behalf. Once you meet the $2,000 threshold, Medicare won’t charge you any further copays on prescription drug costs for the rest of 2025.
2. New prescription drug payment plan
In addition, Medicare is rolling out a new prescription payment plan that will help you spread your costs throughout the year. However, this doesn’t reduce what you owe. It’s an optional feature that you must select if you’d like to participate.
Those who participate in the payment plan will not have to pay anything when they go to the pharmacy. Instead, their Part D plan provider will send them a bill for a portion of their prescription drug costs for the year so far. This could be advantageous if you have a lot of prescription costs early in the year. But it may not help you much if you incur most of your costs later in the year. You can learn more about the payment plan option on Medicare’s website.
3. Increased limitations on telehealth services
Medicare beneficiaries can access telehealth services from anywhere through the end of 2024. But beginning in 2025, these services won’t be covered unless you’re in an office or a medical facility located in a rural area.
There are a few exceptions to this rule. They are:
- Monthly end-stage renal disease (ESRD) visits for home dialysis
- Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke wherever you are
- Services to treat a substance use disorder or co-occurring mental health disorder or for the diagnosis, evaluation, or treatment of a mental health disorder
- Behavioral health services
- Diabetes self-management training
- Medical nutrition therapy
If you qualify for one of the above exceptions, telehealth services are still covered no matter where you are. However, you’ll still owe your Part B deductible and 20% of the Medicare-approved amount.
4. Additional screenings at annual wellness visit
All Medicare beneficiaries are entitled to an annual wellness visit that assesses your current health and gives you advice on how to manage existing conditions. Beginning in 2025, this visit will include screenings for cognitive decline as well as evaluations for substance use disorders, if needed.
5. New caregiver training resources
If your healthcare provider deems that caregiver training is appropriate for your treatment plan, your caregiver can receive individual or group training sessions that are covered by your Medicare plan in 2025. You do not have to be present at these training sessions, but they must focus on your health goals and skills relevant to your care.
Medicare is also rolling out a new pilot program for those living with dementia and their family members and caregivers. Check with your healthcare provider to see if it’s participating in this program.
6. New benefit program for U.S. Postal Service workers
Beginning next year, U.S. Postal Service employees will no longer get benefits through the Federal Employee Health Benefits (FEHB) program. Instead, they’ll be under their own Postal Service Health Benefits (PSHB) program. You can learn more about this on the U.S. Office of Personnel Management website.
This rule probably doesn’t apply to most people, but keep the others in mind as we move into 2025 even if they don’t seem relevant now. You may not think you’ll need caregiver training, for example, but if you experience a serious injury or illness next year, this might become very important to you. So make a note of these key changes and keep them in mind during the new year.