What Changes Are Coming to Medicare in 2025?

Medicare undergoes updates each year, and 2025 brings several important changes.

From premium adjustments to updates in drug coverage, telehealth services, and caregiver support, here’s a comprehensive look at what’s ahead for Medicare enrollees nationwide.

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1. Medicare Part B Premium and Deductible Increases

In 2025, the standard Medicare Part B premium will increase to $185—an increase of $10.30. High-income beneficiaries may see higher premiums due to income-related adjustments.

The Part B deductible is also rising to $257 (a $17 increase). Beneficiaries must meet this deductible before Medicare begins covering healthcare costs.

2. New Income-Related Monthly Adjustment Amount (IRMAA) Chart

Higher-income beneficiaries pay additional premiums known as IRMAA.

These rates vary based on tax filing status and Part B coverage type. The 2025 chart reflects these updated amounts.

3. Medicare Part A Premium and Deductible Changes

Most enrollees won’t pay a premium for Part A, but for those who do, the premium increases slightly:

• $285/month (up $7) for individuals with 30+ quarters of coverage.
• $518/month (up $13) for individuals with fewer than 30 quarters of coverage or certain individuals with disabilities.

Coinsurance and deductibles for hospital stays are also increasing.

4. Drug Price Negotiations

Under the Inflation Reduction Act, Medicare is negotiating lower prices for select Part B and Part D medications. The first 10 drugs will see price reductions of 38%-79%, effective 2026.

In 2025, Medicare will select 15 additional drugs for price negotiations, with reductions taking effect in 2027.

5. Expanded Mental Health Coverage

Medicare will continue covering mental health services like outpatient care for depression and anxiety. Starting in 2025:

• A free "social determinants of health risk assessment" will be added to annual wellness visits.
• Cognitive assessments will screen for dementia and Alzheimer’s disease.
• Doctors will also assess substance abuse risk factors.

6. New Caregiver Training and Support

Medicare will expand caregiver support in 2025 to include training for tasks like administering medications and providing better at-home care.

A new pilot program will offer additional support for people living with dementia and their caregivers.

7. Telehealth Updates

Starting in 2025, most telehealth services will only be covered if accessed from a medical facility in a rural area.

However, some services will still be available from home, including:

• ESRD home dialysis visits
• Behavioral health and substance use disorder treatments
• Diabetes self-management training
• Nutrition therapy

8. More Flexible Enrollment for Low-Income Beneficiaries

Starting in 2025, individuals eligible for both Medicare and Medicaid or enrolled in the Low-Income Subsidy (LIS) program can make monthly plan changes instead of quarterly.

9. Major Changes to Medicare Part D

• Fewer Standalone Plans: The number of Prescription Drug Plans (PDPs) will drop by 26%, with at least 12 options still available in each state.
• Premium-Free Plans: Plans for LIS recipients will decrease by 9%.
• Cap on Out-of-Pocket Costs: Annual out-of-pocket drug costs will be capped at $2,000, starting in 2025.
• Prescription Payment Plans: A new payment plan will allow beneficiaries to spread out drug costs over the year.

Conclusion

Those are the major Medicare changes to expect in 2025.

If you have any questions about how these changes will affect you or your coverage, give us a call at 833-801-7999, and our licensed insurance agents will be happy to help you!