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Big Medicare Changes Are Coming in 2025

Check out the articles below for more information on the upcoming  Medicare changes. 

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Questions? Please contact me to schedule an appointment. 

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7 Key Medicare Changes for 2025

 If you or someone you love is a Medicare Advantage and Part D enrollee, these changes may enhance your protection and offer coverage that aligns more closely with your individual needs and preferences. For a complete list of updates, click here.  

 

  1. New Compensation Structures for Agents and Brokers: To prioritize the health care needs of enrollees, CMS has introduced a new compensation model for agents and brokers. This change is designed to better align compensation with the existing requirement that agents and brokers enroll individuals in the plans that best fit their health care needs.

  2. New Protections Against Unwanted Marketing: The new rule sets clear limitations on how third-party marketing organizations (TPMOs) can use your personal data. To protect you from invasive marketing tactics, TPMOs will now require explicit written consent before they can collect or distribute your personal information for marketing purposes.

  3. Strengthened Regulations on Marketing Practices: The rule includes new regulations for marketing and communications of Special Supplemental Benefits for the Chronically Ill (SSBCI) to prevent misleading marketing practices that may impact enrollment decisions.

  4. Expanded Access to Behavioral Health Services: CMS is updating its network adequacy standards to ensure broader access to behavioral health care providers. A new provider category has been added, emphasizing CMS's focus on improving access to comprehensive care and supporting the mental well-being of Medicare beneficiaries.

  5. Mid-Year Notification of Available Supplemental Benefits: Medicare Advantage plans must notify you mid-year of unused supplemental benefits such as vision, hearing, fitness, and dental to ensure awareness and utilization of available benefits.

  6. More Rights to Appeal a Decision to Terminate Coverage for Non-Hospital Provider Services: If you have a Medicare Advantage plan, you now have additional rights to appeal decisions to terminate coverage for non-hospital provider services.

  7. Updates to Medicare Part D Medication Therapy Management (MTM) Program: The revisions ensure that individuals have reliable and increased access to MTM services. As part of these changes, HIV/AIDS has been included in the list of core chronic diseases for eligibility, potentially improving patient access to medication management and related health care support.

Medicare Part D Changes for 2025

The Centers for Medicare & Medicaid Services (CMS) recently announced plans to overhaul the Medicare Part D prescription drug program significantly. Thankfully, these changes will reduce out-of-pocket expenses, expand drug coverage, and simplify the program's structure for easier navigation. Key changes include:

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  • Capped Out-of-Pocket Expenses: Beginning in 2025, your annual out-of-pocket spending for covered Part D drugs will not exceed $2,000. This change is particularly beneficial if you take high-priced medications.

  • Elimination of the Coverage Gap: Beginning in 2025, Part D will simplify down to three phases: deductible period, initial coverage, and catastrophic coverage. The re-design of Part D eliminates the phase of the coverage gap (also known as the donut hole) that currently follows the initial coverage phase and where you generally pay more for covered medications. Removing the coverage gap means you will no longer face a change in your cost sharing when transitioning from the initial coverage phase.

  • Medicare Prescription Payment Plan: Beginning in 2025, each Medicare prescription drug plan must allow members to pay out-of-pocket prescription costs in capped monthly installments rather than all at once at the pharmacy. This applies to Advantage plans with Part D as well. 

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Contact Me

Given these changes, I recommend scheduling a consultation to discuss how these adjustments may impact your health care. We can explore whether your current plan will continue to be the most beneficial or if a change is in order during October annual enrollment.

To schedule an appointment:

Email - jen@jenniferbellbenefits.com

Call or Text Beth - 720-665-6015

To reach me directly:

Call - 720-626-6524

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