> Medicare Changes for 2025 - What to Know

In 2025, several Medicare Advantage plans will no longer be available in New Hampshire, impacting many beneficiaries who rely on these plans for their healthcare coverage. Notably, Harvard Pilgrim Health Care has announced that it will not offer its Stride℠ (HMO/HMO-POS) Medicare Advantage plan in New Hampshire starting in 2025. This decision means that coverage under this plan will end on December 31, 2024, affecting numerous enrollees who will need to find alternative coverage options. 

The discontinuation of these plans is part of a broader trend affecting Medicare Advantage enrollees nationwide. According to recent analyses, more than 1.8 million Medicare Advantage members across the United States are enrolled in plans that will not be offered in 2025.  This represents a significant increase compared to previous years, highlighting the importance for beneficiaries to review their coverage options during the open enrollment period, which runs until December 7, 2024. 

For those affected in New Hampshire (or any other state), there are a few key steps to take. First, it is crucial to review the annual notice of change provided by the current insurer to understand the specific details of the plan termination and any recommended actions. Beneficiaries will need to actively select a new Medicare Advantage plan or transition back to Original Medicare. If no action is taken, they will be automatically enrolled in Original Medicare. 

Despite the discontinuation of some plans, there will still be a variety of Medicare Advantage options available. On average, beneficiaries in New Hampshire will have access to around 34 different Medicare Advantage plans with drug coverage in their county for 2025.  This ensures that most individuals will have ample choices to find a plan that meets their healthcare needs and budget. 

In summary, while the non-renewal of certain Medicare Advantage plans for 2025 presents challenges, it also underscores the importance of proactive plan review and selection during the open enrollment period to ensure continuous and adequate healthcare coverage.   

Improvements to Medicare Plans for 2025 

Medicare, the federal health insurance program for people aged 65 and older, as well as certain younger individuals with disabilities, is set to undergo significant changes in 2025. Many of the changes to Medicare in 2025 are a result of the Inflation Reduction Act of 2022. This legislation aimed to reduce healthcare costs and improve access to care for Medicare beneficiaries.  The introduction of the $2,000 out-of-pocket cap, elimination of the donut hole, and expanded support for caregivers are all part of the broader efforts to make healthcare more affordable and accessible. 

Here are the key changes to Medicare and their potential impacts: 

Elimination of the Medicare Part D "Donut Hole” 
The infamous "donut hole" in Medicare Part D, where beneficiaries had to pay a higher share of their drug costs after reaching a certain spending threshold, will be eliminated in 2025. This means that once beneficiaries hit the $2,000 out-of-pocket cap, they will not have to pay anything more for their covered medications for the rest of the year.  This change simplifies the payment structure and reduces the financial burden on those with high prescription drug costs. 

New Payment Plan Options 
Medicare will introduce a new payment plan option that allows beneficiaries to spread out their medication costs over the year. This opt-in plan is designed to help those who may struggle with large upfront costs for their prescriptions.  By distributing the financial burden more evenly, this plan aims to make it easier for beneficiaries to manage their healthcare expenses. 

Expanded Support for Dementia Caregivers 
A new program called Guiding an Improved Dementia Experience (GUIDE) will be introduced to support caregivers of people with dementia. This program will offer up to $2,500 annually for dementia-related respite care, providing much-needed relief and support for caregivers.  This initiative recognizes the critical role caregivers play and aims to improve the quality of life for both caregivers and those they care for. 

Increased Access to Mental Health Services 
Medicare will expand access to mental health services by encouraging more mental health counselors to enroll as providers. This change is intended to address the growing need for mental health care among Medicare beneficiaries.  By increasing the availability of mental health professionals, Medicare aims to ensure that beneficiaries can receive timely and appropriate care for their mental health needs. 

Stricter Marketing Rules for Medicare Advantage Plans 
To protect beneficiaries from misleading marketing practices, Medicare will implement stricter rules for Medicare Advantage plans. These rules will require clearer communication about plan benefits, costs, and coverage options. The goal is to ensure that beneficiaries have accurate and transparent information when choosing their Medicare Advantage plans, helping them make more informed decisions. 

Enhanced Benefits for Family Caregivers 
In addition to the GUIDE program, Medicare will offer expanded benefits for family caregivers. These benefits may include training, counseling, and support services to help caregivers manage their responsibilities more effectively. By providing additional resources and support, Medicare aims to improve the well-being of both caregivers and the individuals they care for. 

Conclusion 

The improvements to Medicare plans for 2025 represent a significant step forward in enhancing the program's coverage and support for beneficiaries. By capping out-of-pocket costs for prescription drugs, eliminating the donut hole, introducing new payment plan options, and expanding support for caregivers and mental health services, Medicare aims to provide better financial protection and access to care. These changes reflect a commitment to addressing the evolving needs of Medicare beneficiaries and ensuring that they receive the care and support they deserve. 

If you have any specific questions or need further details about these changes, please contact your Ledyard Financial Advisor or reach out to Jeff Trombly, our Medicare specialist at 603-640-2733 or jeff.trombly@ledyard.bank.