Prepare for Medicare Changes During Open Enrollment

Health insurance advisors have an important piece of advice for Medicare recipients. When you receive your Medicare plan renewal notice this fall, don’t toss it in the trash! With several significant changes to Medicare coverage expected for the coming year, you need to review your coverage carefully.

“The plans change every year, and this year is going to be incredible,” says Carrie Fortuny-Gonzalez, a SHINE program manager for the Northeast Florida region. SHINE, which stands for Serving the Health Insurance Needs of Elders, is the free, unbiased Florida health insurance assistance program. “People say, ‘I’m happy; I don’t want to change my plan.’ But your plan may have changed, and you won’t even know about it.”

Open enrollment begins Oct. 15 and ends Dec. 7. This is the period when Medicare recipients are free to join, drop or switch plans for both traditional Medicare and Medicare Advantage. Beginning in October, you will receive renewal notices in the mail that may be labeled “Evidence of Coverage” or “Annual Notice of Change.” That’s the time to start doing your homework, Fortuny-Gonzalez says.

One of the biggest changes this year is a cap on prescription drug spending under Medicare Part D (the prescription drug plan). Once an individual reaches $2,000 in out-of-pocket costs, there are no further costs for drugs taken at home for the remainder of the year.

This change is mandated as part of the Inflation Reduction Act, which President Joe Biden signed into law in 2022. The cost savings may be significant for some consumers with Medicare Part D. In 2024, out-of-pocket drug costs needed to reach $8,000 before being capped.

The new law “will completely eliminate the donut hole,” which is the cost consumers pay after they reach a certain coverage limit but before “catastrophic” coverage kicks in, Fortuny-Gonzalez says. “It’s the first time the government has negotiated a cap for prescription medications at $2,000. It’s really doing justice to seniors, especially those who take so many medications.”

Another change will further help consumers manage prescription drug costs. Medicare members with Part D coverage can spread their prescription drug out-of-pocket costs into monthly payments over the year. This will help people who would have high drug costs at the start of the year to redistribute the costs to a manageable monthly payment. The program is voluntary.

Prepare for higher premiums

Consumers may find, however, that the lower out-of-pocket costs for prescription drugs may result in higher deductibles or premiums.

“We suspect the Part D plan costs will go up. They have to compensate for the money they won’t get from the medication,” Fortuny-Gonzalez says.

Consumers may also find that Medicare Advantage plans have cut back on some of the “extras,” like dental or vision coverage, or will reimburse those services at a lower rate. Consumers are often attracted to Medicare Advantage plans because of dental and vision coverage, she notes.

Other changes for this year include changes in insulin costs. Out-of-pocket insulin prices will be capped at $35 per month. And more help for prescription drug costs is coming — but not until 2026. The Biden administration authorized Medicare to negotiate with pharmaceutical companies to lower the prices on several popular, expensive prescription drugs beginning in 2026 under the Medicare Part D plan. These drugs include: Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, Fiasp and NovoLog insulin products.

This is the first time the federal government has directly negotiated with pharmaceutical companies to influence Medicare drug prices, Fortuny-Gonzalez says. The government is expected to continue to negotiate drug prices in the coming years for several popular drugs.

Help with Open Enrollment

If you are satisfied with your current Medicare plan, Medicare Advantage plan or supplemental plan, you will automatically be renewed in your current plan. Although, as advised, it’s best to review your 2025 plan carefully.

Seniors can compare all options and search for plans in their area by visiting the Medicare website. Those who need assistance are encouraged to contact the SHINE program by calling Florida’s Elder Helpline toll-free at 1-800-96-ELDER (800-963-5337) and asking for a SHINE volunteer counselor. You can also request SHINE assistance by visiting their website. SHINE offers services at the Nassau County Council on Aging. For more information, call 904-261-0701.

“SHINE is free and unbiased. That’s what we do,” Fortuny-Gonzalez says. She urges seniors to look closely at their plans and drug formularies. If it’s too confusing, reach out for help.

“My biggest advice is to compare plans every year,” she says. “There are always some changes in your life and health. Take the time to talk to someone neutral who isn’t trying to sell you what they have. Health insurance is not one-size-fits-all.”

Even with a $2,000 prescription drug cap, review your medications carefully, she says.

“The first thing we ask you is for a list of your medications,” she says. “We will look plan-to-plan to see what covers most of your medications. I think that is the wisest thing to do every year.”