By Cindy Jarmusz

Medicare Annual Enrollment for 2025 is October 15 to December 7, 2024. If you don’t make changes, you will automatically be enrolled in the same plan you currently have. It’s important to know that the Inflation Reduction Act’s federally mandated changes to prescription drug coverage, effective January 1, 2025, will impact Stand-Alone Prescription drug plans and Medicare Advantage plans that include prescription coverage.

Individuals with high drug costs will benefit from these changes in 2025, but those with lower drug costs could pay more. Here’s why.

  • Removal of the coverage gap eliminates the “donut hole” period during which individuals pay 25% of a medication’s cost.
  • Out-of-pocket maximum is reduced from $8000 to $2000, with insurance carriers responsible for a bulk of the difference.
  • A new M3P optional payment plan nicknamed “Co-Pay Smoothie” allows members to spread prescription cost payments over the plan year, requiring insurance carriers to assume the huge responsibility of implementing the plan.
  • There will be a mix of increased premiums, changes in cost-sharing, adjustments to formularies with medication changes, restriction changes, tier shifting, and plan cancellations.

Pay attention to communications from your insurance carrier. The Annual Notice of Change (ANOC) is a required document mailed in September to let you know how your plan will change in 2025. When you receive it:

  • Make sure you are okay with all of the changes, including the premium, cost-sharing costs, and medical and drug coverage.
  • Confirm your prescription medications are still on your plan’s formulary and understand cost-sharing. Formularies and drug prices vary among carriers and sometimes between the same carrier’s plans.
  • Confirm that your providers are still in-network and SHOP, SHOP, SHOP!

Work with a FREE licensed educated Medicare advisor who understands federal and state laws and insurance plan changes.

  • Mistakes can be costly — what you don’t know CAN hurt you! You can work with a local advisor contracted with local and national insurance carriers to receive unbiased expert advice based on your individual needs.
  • Don’t trust famous-actor TV ads, mailers, and 1-800 call centers, don’t get stuck in a plan that doesn’t meet your needs, and don’t pay more than you should!
  • Review your 2025 options and ask for FREE expert help that may save you money
  • If someone calls and says they are from Medicare, hang up. Medicare will never call you!

Cindy Jarmusz is a licensed insurance agent/broker with 20+ years of experience as a RN/CaseManager who understands the health care system and the unique health needs of seniors. Cindy founded CJ Cares Insurance Agency. Call her at 716-403-4433 for a free unbiased assessment of your Medicare insurance needs before choosing your 2025 Medicare Advantage plan. Stay tuned for more information in November’s Buffalo Healthy Living.