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Open enrollment is nearly upon us for Michigan residents age 65 and older seeking Medicare coverage for 2025.
Eligible applicants can choose the plan that’s right for them between Oct. 15 and Dec. 7. Those health care selections will go into effect Jan. 1, 2025.
Thanks to passage of the federal Inflation Reduction Act of 2022, Medicare coverage has undergone sweeping changes aimed at reducing prescription drug costs and improving access to health care.
“This year has probably the biggest changes we’ll see in Medicare Advantage probably since the inception,” said Scott Norman, vice president of Medicare for Priority Health. “It’ll really reshape how folks get coverage for their prescriptions.”
MLive is hosting an event to help understand the changes. “The Guide to Medicare and Golden Retirement,” sponsored by Priority Health, is planned for Tuesday, Oct. 22, beginning at 4:30 p.m. It’s free and virtual – just register at https://events.mlive.com/medicare and log onto your computer that afternoon.
Medicare is the U.S. health insurance program available to residents 65 and older, as well as some younger people with disabilities or end-stage renal disease. There are different types of plans that range in cost and coverage.
Traditional Medicare can include Part A (hospital), Part B (medical), and Part D (prescription drugs), as well as options for supplemental coverage. There are also Medicare Advantage plans, also known as Part C, which combine Part A and Part B and are provided by private insurance companies approved by Medicare.
In the past, most Medicare drug plans had a coverage gap — nicknamed the donut hole — in which patients have exceeded their coverage but haven’t yet reached the threshold where catastrophic coverage kicks in.
However, the Inflation Reduction Act included the addition of a $2,000 out-of-pocket cap for Medicare drug coverage, starting in 2025. Once your drug costs reach that threshold, you won’t have to pay coinsurance or copayments for the rest of the year.
For recipients who have expensive prescription drug costs they can’t afford all at once, there will be an opportunity to make monthly installments with no interest. Norman noted it’s a new program and he recommended patience as pharmacies and providers figure out the new options.
“It’s really about access to care and we administer that on behalf of our members,” Norman said. “Anytime you have a new program there’s always bumps in the road. The best thing is to contact your health plan and ask some questions about it.”
Like 2024, the cost of insulin has been capped at $35 per month. Further cost reductions for some of the most popular and expensive prescription drugs are being negotiated. Reduced prices won’t take effect until 2026.
Aside from the prescription drug savings, Norman said people who have already been enrolled in Medicare Advantage plans in the past may notice some changes this year in the form of higher out-of-pocket costs, slightly higher premiums, or deductibles.
“Because of some of the regulatory changes that have happened over the last couple of years and this persistent high medical utilization we’ve seen, you’re seeing a little bit of a pullback in some of the benefits and adjustments to benefits,” he said.
With the changes coming to Medicare coverage in 2025, officials recommend getting an early jump on preparation. Talk with a local independent agent, review your plan options, and make sure your doctors and prescription drugs are covered under your chosen plan.
Below are some additional Medicare FAQs to help first-time eligible residents.
When should I start looking into Medicare?
Whether you’re aging into Medicare eligibility for the first time, or are due to re-up your coverage, it’s a good idea to evaluate what type of plan will best fit your lifestyle in 2025.
An individual’s first chance to sign up for Medicare begins three months before they turn 65, and ends three months after they turn 65. It’s called the “initial enrollment period.”
There are also special enrollment periods for certain life events, like moving or losing or changing employers.
Are people automatically enrolled in Medicare when they turn 65?
There are some cases in which a person is automatically enrolled in Medicare Part A and Part B, such as if they have been approved for or already receive Social Security or Railroad Retirement Board benefits.
Otherwise, no, you likely aren’t automatically enrolled and would need to choose a plan when you become eligible.
What happens if I miss the enrollment deadline?
If you don’t enroll in a Medicare plan when you’re first eligible, and you don’t defer coverage through the Social Security Administration, there may be a penalty for enrolling at a future date. Those penalties may be added to your monthly premium for as long as you have coverage.
What are some things to think about when choosing a plan?
Among the main things to consider when choosing a Medicare plan are whether your doctor is covered; whether your prescription drugs are covered; if you travel often and would like travel coverage; and if there are additional services you’d like covered like dental, vision and/or hearing, or a gym membership.
What are the available resources to help guide me through my Medicare enrollment?
Resources are available through Social Security, the Centers for Medicare & Medicaid Services (CMS), and your local Area Agency on Aging. You can also contact local carriers to get recommendations for a local agent.
Michigan offers free and unbiased assistance in reviewing and comparing plans through its Michigan Medicare/Medicaid Assistance Program (MIMAP) at 800-803-7174 or through its website at mmapinc.org.
You can also visit https://www.medicare.gov/ or call Medicare’s toll-free assistance line at 1-800-633-4227.
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