Look at the premium, deductible, copay, and maximum out-of-pocket costs from your plan this past year and compare them to what is offered this year. Experts say you need to consider all factors when making your final decision.
There are more coverage options for Medicare beneficiaries during open enrollment than just a decade ago, making choosing the right plan difficult.
Whether you're enrolling in Medicare benefits for the first time or want to ensure you have the right plan as changes are implemented, experts said it is important to compare plans during open enrollment.
Enrollees have until Dec. 7 to choose their health and drug plans for the upcoming year. The average beneficiary has 43 Medicare Advantage plans and 21 stand-alone Part D plans to choose from during that time, according to nonprofit health policy research group KFF. That's more than twice as many Advantage plans and slightly fewer Part D options than a decade ago.
Experts said there are a few ways enrollees can navigate all these choices to ensure their Medicare plan is best suited for them.
Enrollees should be especially aware of Medicare's significant changes this year. While Medicare premiums and deductibles often change yearly, changes to the structure of the programs, especially for Part D, will significantly change offerings.
In 2024, the out-of-pocket limit for Part D drug expenses was between $3,300 and $3,800. This coming year, enrollees must only pay $2,000 on out-of-pocket medications before Medicare covers the rest.
Previously, there was a gap between what most Part D plans would cover, which this rule change will eliminate. Although the $2,000 cap will reduce some payments, the maximum deductible for Part D plans will increase to $590 in 2025 from $545 in 2024. Only some Part D deductibles will rise and will most likely only affect those who take several expensive medications.
"Historically, individuals have paid a significantly higher portion for their prescription drugs. With this $2000 max out-of-pocket costs, it will hopefully allow more individuals to access their needed medication," said Jennifer Teague, director for health coverage and benefits for the National Council on Aging.
All plans with drug coverage will now offer an optional Medicare Prescription Payment Plan (MPPP). If you decide to opt in, the plan won't reduce your drug costs but will spread out the payments over the year to help you pay them off more easily.
Experts suggest that enrollees know the health care providers they prefer to use and the different benefits they want covered before enrolling.
Knowing how your Medicare plan's premiums, deductibles, co-pays, and maximum out-of-pocket costs from the past years can help you choose the best Medicare plan for the upcoming year. Experts recommend calculating how much you can pay in monthly premiums and if you are willing to increase your out-of-pocket expenses.
"It is a complicated balance, which is why we recommend that people take a big, kind of overarching look at what these plans are offering," said Leigh Purvis, prescription drug policy principal at AARP.
Although the monthly premium may be lower, don't just look at the premiums, Purvis said. The deductible could be higher, and you could end up paying more out-of-pocket healthcare costs.
"You want to have a general idea of what your expenses are and have been, and use that as a way to look at the plans for the coming year and see whether they're comparable or whether there's a plan that could potentially be less expensive but still able to meet your needs," Purvis said.
All Medicare enrollees are required to sign up for Medicare Part A and B, also called Original Medicare. These combined plans help cover inpatient care and outpatient care.
Some enrollees may find it beneficial to add Medicare Part C, or Medicare Advantage, to their Original Medicare. This plan offers additional benefits included in coverage and annual limits on out-of-pocket costs, but it restricts doctors and hospitals you can go to.
"No one is required to enroll in a Medicare Advantage plan," said Rachel Gershon, senior attorney at Justice in Aging. "If somebody does enroll in Medicare Advantage, it's a good idea to think about which providers, such as which hospitals or which doctors you might want to keep seeing in the new year, and check with the potential plan to see if they're in network."
State Health Insurance Assistance Program (SHIP) counselors can help you review the plan options offered in your area and decide on the best plan for the coming year. The SHIP program is a nonpartisan, federally funded group that provides resources and one-on-one counseling for Medicare enrollees.
"The choice of whether to join a Medicare Advantage plan and which Medicare Advantage plan to join is a very personal choice based on your own circumstances," said Gershon. "So we would recommend going to a SHIP counselor to work out that information."