The 2025 Medicare Open Enrollment Period has brought significant changes, particularly in Medicare Advantage (MA) and Part D prescription drug plans. These changes, driven by policy revisions and insurer adjustments, could impact millions of beneficiaries. Here's a breakdown of the most critical updates and what they mean for you.
Fewer Plans, Fewer Options
The availability of Medicare Advantage and Part D plans is shrinking. CMS data reveals a 6.6% reduction in Medicare Advantage plans with prescription drug coverage for 2025 compared to 2024. Major insurers like UnitedHealth Group and Humana are cutting their offerings by 5.4% and 2.5%, respectively.
On average, beneficiaries will have access to 34 Medicare Advantage plans per county, down from 43 in 2024. Notably, Medicare Advantage plans serving 1.5 million beneficiaries will be eliminated, and an estimated 3.5 million people will lose their Part D plans, according to Healthpilot.
Premiums Drop, But Costs May Rise
While the average monthly premium for Medicare Advantage plans is set to decrease to $17.00 in 2025 (down from $18.23 in 2024), premiums are just one piece of the cost puzzle. Beneficiaries should also consider deductibles, copayments, and the potential for reduced supplemental benefits, such as dental, vision, or fitness programs. CMS has implemented measures that may make these plans less profitable for insurers, which could lead to fewer perks for enrollees.
When reviewing plans, pay attention to the maximum out-of-pocket cost—the most you could spend annually on in-network care, including deductibles and copayments. However, this figure often excludes costs for supplemental benefits or out-of-network care, which can add up significantly.
Changing Provider Networks
Some healthcare providers are choosing to opt out of Medicare Advantage plans. For instance, Sanford Health will no longer accept Humana’s Advantage plans, while Essentia Health is dropping plans from UnitedHealthcare and Humana. These decisions reflect ongoing frustrations among providers over low reimbursement rates and frequent claim denials.
If your preferred doctors or hospitals are no longer in your plan’s network, you could face higher costs for out-of-network care or need to find new providers. It’s essential to verify provider participation during Open Enrollment to ensure your plan still meets your needs.
New Challenges for Part D
Significant changes are also on the horizon for Part D prescription drug plans. CMS reports a 25% reduction in the number of Part D plans available for 2025, marking the lowest availability since the program began. Many remaining plans feature higher premiums, deductibles, and copayments, which could increase out-of-pocket expenses.
Additionally, drug formularies—the list of covered medications—may be revised. Drugs might be dropped from coverage or moved to higher-cost tiers, leading to higher costs for beneficiaries.
Why It’s Critical to Review Your Options
Historically, many Medicare beneficiaries have neglected to review their plans during Open Enrollment. In 2021, 65% of Medicare Advantage enrollees didn’t compare plans, and 43% didn’t even check changes to their existing coverage, according to the Kaiser Family Foundation. With so many changes this year, it’s more important than ever to carefully evaluate your options.
For those considering a switch to Original Medicare, be aware of potential gaps in coverage. While Medigap policies can fill most of these gaps, insurers may deny coverage or charge higher premiums based on medical history unless you're switching because your Medicare Advantage plan was discontinued.
Resources to Help Navigate Open Enrollment
Comparing plans can be overwhelming, but you don’t have to do it alone. Visit our Compare Your Plan page to start comparing 2025 Medicare Advantage plans available in your area! You can also schedule a meeting with a Medicare Expert in your area by visiting our Find an Agent page. If you'd like to view all 2025 Medicare Advantage plans in your area, visit our See All Plans page.
Another excellent resource is the State Health Insurance Assistance Program (SHIP). SHIP offers free, federally-funded assistance through trained volunteers who can help you understand your coverage options and make informed decisions.
Take Action
Open Enrollment runs from October 15 to December 7, giving beneficiaries a limited window to make changes. Don’t wait—review your plan details, check provider networks, and compare options to ensure your 2025 coverage meets your needs.
With fewer plans and rising costs in some areas, being proactive is the best way to protect your health and finances in the year ahead.
Have questions? Feel free to contact us!
