What Hydrocephalus Patients Should Know for Medicare Open Enrollment

As Medicare beneficiaries navigate through the open enrollment period, it is crucial for them to understand the surplus of 2025 changes as they choose a new Medicare insurance plan. The Medicare Open Enrollment Period began on October 15 and will close on December 7th. 

Each year, seniors have the ability to join, switch or drop their Medicare Advantage plan during the annual Medicare Open Enrollment period. Medicare Advantage companies usually tweak existing plans and remove some plans from the market. The Open Enrollment period provides seniors time to evaluate the array of new plans and various changes that will be provided for the following year. There are some key changes to be aware of in the 2025 plans.

Prescription Drug Costs:

Changes will dramatically change what many seniors pay for prescription drugs. A result of the Inflation Reduction Act (IRA), Medicare drug plans (Medicare Advantage plan with prescription drug coverage or a standalone Part D Prescription Drug Plan) will include a $2000 cap on out-of-pocket costs, which includes deductible, copay, and coinsurance payments. There will also be a monthly out-of-pocket cap of $35 for insulin payments.

Prescription Payment Plans:

Beneficiaries will be given the flexibility to choose how they want to pay their plan’s drug costs through Medicare Prescription Payment Plans. The new option allows enrollees to spread out the costs of the prescription drug throughout the year. All plans will provide this option. It is not mandatory for beneficiaries to participate. The option does not change the overall cost of prescription drugs for your Medicare plan.

Special Enrollment Periods:

Changes also impact the availability of Special Enrollment Periods for certain beneficiaries. Low-income seniors dually enrolled in Medicare and Medicaid or who receive low-income subsidies (Extra Help Program) will be eligible for a monthly special enrollment period. During this time, they will be able to drop a Medicare Advantage plan to enroll in traditional Medicare and a standalone Part D Prescription Drug plan.

Individuals that qualify for both Medicare and Medicaid enrolled in a Dual Eligible Special Needs Plan (D-SNP) may also have access to a new special enrollment period. The new Integrated Care Special Enrollment Period will allow some dually eligible seniors to join and switch specific types of D-SNPs on a monthly basis. Not all beneficiaries are eligible as they must be on a D-SNP designated as “integrated or aligned”.

Remember, outside of the regular Open Enrollment period happening now, seniors have the ability to switch or drop their Medicare Advantage plan during the Medicare Advantage Open Enrollment Period that runs from January 1st through March 31st. Additionally, some seniors may also qualify for Special Enrollment Periods (SEP) due to a qualifying life event, like moving or losing other insurance coverage, which fall outside of the traditional enrollment periods.

For those interested in learning more about the recent changes, Medicare.gov has published RESOURCES that detail the new changes.