Preparing for Medicare Changes in the New Year

Commentary December 20, 2024 at 02:34 AM
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What You Need To Know

  • IRMAA tiers have changed.
  • Vaccinations will be free.
  • Prescription drug spending could be more predictable.
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As 2025 approaches, Medicare beneficiaries are preparing for important updates to premiums, income-related charges, and prescription drug costs.

These changes, many stemming from the Inflation Reduction Act, aim to reduce financial burdens and improve access to care.

However, they also bring new complexities that require proactive planning.

Medicare advisors play a crucial role in helping beneficiaries navigate these reforms and adjust their plans to make the most of their coverage.

A client recently asked, "Why have my Medicare premiums increased, and what should I expect with changes coming in 2025?"

Premium increases are a normal part of Medicare's annual adjustments, often tied to inflation and health care cost trends.

In 2025, these adjustments will coincide with benefits significant changes.

While these updates are generally positive, beneficiaries should carefully review how these changes will affect their overall expenses and consider if any action is needed.

Key 2025 Changes and How to Prepare

1. Prescription Drug Cap:

What's changing? Starting in 2025, Medicare Part D out-of-pocket costs will be capped at $2,000 annually, eliminating the possibility that beneficiaries could face unlimited expenses after they reach the catastrophic coverage phase.

What it means for beneficiaries: Those with high medication costs will see significant savings, a simplified cost-sharing structure and greater financial predictability.

Advisor tip: Ensure your clients are aware of their total premium cost for 2025, including the increased Part B and Part D premiums.

2. Medicare Part B Premium Adjustments:

What's changing? Premiums for Medicare Part B outpatient and physician services coverage will adjust for inflation. The surcharge known as the income-related monthly adjustment amount, or IRMAA, will apply to higher-income beneficiaries. The IRMAA adjustment tier for 2025 premiums will be based on beneficiaries' modified adjusted gross income for 2023.

What it means for beneficiaries: Inflation-based adjustments to IRMAA brackets could shift some beneficiaries into different IRMAA tiers.

Advisor tip: Help clients understand their MAGI calculation and appeal IRMAA surcharges if their income was temporarily elevated in 2023 due to unusual life events, such as a retirement or a one-time capital gain.

3. Additional Benefits Under the Inflation Reduction Act:

What's changing? Free vaccines recommended by the Advisory Committee on Immunization Practices and caps on annual Medicare Part D prescription drug plan premium increases will take effect.

What it means for beneficiaries: Reduced costs for preventive care and predictable premiums.

Advisor tip: Educate clients about these benefits and encourage them to utilize preventive services.

Broader Considerations And Looking Ahead

While the new drug cap and premium adjustments are major developments, beneficiaries must still plan for other health care expenses, such as deductibles and co-payments.

Medicare Advantage plans or Medicare supplement insurance plans (also known as Medigap plans) may provide additional cost-sharing options, depending on the beneficiary's needs.

Advisors can provide value by helping clients evaluate whether their current plans still meet their health care and financial requirements.

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