We are beginning to take 2025 certification courses from all the Medicare Advantage carriers that we use. Although we will not know actual 2025 plan details for sometime yet, we expect that all insurance carriers will have significant plan changes. More than likely, premium rates will increase, and some benefits will decrease.
Why such a gloomy prediction? There are several factors:
1. As many of you know, Medicare pays an insurance carrier about $1000 per month so that the insurance carrier and not Medicare is responsible for your medical bills. That dollar allotment has stayed constant or increased over each of the last 5 years or so. When someone asks how an insurance company can pay such great benefits for a low or even $0 premium, it is because almost all of the premium is coming from Medicare and not the beneficiary themselves. For the 2025 plan year, the Medicare allotment to all insurance carriers is being reduced.
2. Insurance companies are claiming that they are now losing money on Medicare plans due to pent up demand for medical services since the national COVID shutdown has ended. (A skeptic might question that when they look at the annual incomes some insurance CEO’s are getting.)
3. Due to recent legislation, the maximum that you can be out-of-pocket on 2025 annual eligible Medicare prescription drugs will be capped at $2000. While that is great news for someone that takes expensive prescriptions, it is bad news for insurance companies that must absorb the additional claim liability.
4. To make the prescription drug picture worse, there has been a huge increase in the use of very expensive drugs like Ozempic and Eliquis.
We will know the 2025 plan details in September and will be permitted to discuss these details with you after October 1st. Be looking for emails from us as of that date. We can then help you evaluate your options. We continue to be licensed to market all of the most popular Medicare Advantage plans here in Western PA.
We suspect that most people will keep the plan that they have. After all, the above changes affect all insurance carriers and, of course, it can be scary to change a plan that you like. However, this fall’s annual enrollment period will warrant your close attention.