The Centers for Medicare & Medicaid Services (CMS) has announced two major changes for Medicare in 2025 that will have significant impacts on beneficiaries. These changes include a crackdown on agents and brokers who sell Medicare policies, a new midyear notification for Medicare Advantage policyholders about unused supplemental benefits, and a new $2,000 annual cap on out-of-pocket prescription costs.
The first change involves ending sales incentives for agents and brokers who enroll Medicare beneficiaries into private insurers’ Medicare Advantage, Medigap, and Part D plans. This move aims to protect seniors from deceptive marketing practices and ensure that salespeople are not influenced by incentives when recommending plans to potential enrollees.
The second change requires Medicare Advantage plans to send policyholders a personalized mid-year notification of unused supplemental benefits each July. This notification will inform beneficiaries about the supplemental benefits they have not used, the costs associated with each benefit, and how to access them.
The third change is the implementation of a $2,000 annual cap on out-of-pocket prescription costs for Part D plans in 2025. This cap will provide relief to beneficiaries who often face high costs for prescription medications and will prevent them from paying more than $2,000 out-of-pocket for covered drugs.
While these changes are intended to benefit Medicare beneficiaries, experts warn that there may be unintended consequences. Some health insurers may respond to the $2,000 cap on out-of-pocket prescription costs by implementing more restrictions on covered medications, increasing premiums, or even discontinuing Part D plans altogether.
Overall, these changes represent a significant shift in how Medicare operates and will have far-reaching implications for beneficiaries in the coming year. It is important for Medicare recipients to stay informed about these changes and carefully review their options to ensure they are getting the best coverage for their needs.