• Medicare is a federal health insurance program for older adults ages 65 and older.

• Open enrollment for 2025 Medicare plans runs through December 7.

• Some major changes in 2025 include a new $2,000 out-of-pocket maximum under Part D, eliminating the plan’s “donut hole” coverage gap and fewer Medicare Advantage plans.

As of January 1, five major changes come into effect Medicare — a federal health insurance program for adults age 65 and older.

Every year, older adults between October 15 and December 7 have to enter in Medicare or change plans.

There is four main parts to Medicare:

• Part A helps cover inpatient care in hospitals, skilled nursing facilities, and home care.

• Part B is for outpatient coverage, such as diagnosing and treating an illness in the doctor’s office, as well as preventive services, such as vaccines and wellness visits.

• Part C– also known as Medicare Advantage plane — is bundled coverage that includes Parts A, B and sometimes D.

• Part D provides coverage for prescription drugs

Medical news today spoke with three Medicare experts to learn more about the biggest changes coming in 2025 and how they could affect readers.

Fewer Medicare Advantage plans by 2025

Starting January 1st, there will be fewer Medicare Advantage plans available.

“Medicare Advantage Plans are the alternative to getting your Medicare through Original Medicare“, said Ryan Ramseyassociate director of health coverage and benefits for the National Council on Aging.

“These plans are offered by Medicare-approved private companies that must follow rules set by Medicare and provide Medicare Part A (hospital insurance) and Part B (health care insurance) coverage, as well as including drug coverage (Part D) in most cases, all under one plan ,” Ramsey shared MNT.

“In most cases, you must use providers that participate in the plan’s network; however, some plans offer out-of-network non-emergency coverage, but usually at a higher cost,” he continued. “These plans may also offer additional additional benefits such as vision, dental or fitness and wellness benefits not covered by Medicare.”

“The number of Medicare Advantage plans that will be available to the average person is expected to decrease by 7%,” Ramsey added. “This could result in fewer additional benefits being offered, smaller networks within plans and an increase in overall costs. However, the number of plans available in 2025 is still among the three largest since 2010.”

No more coverage gap in Part D “donut hole”.

Starting January 1, a new method for Medicare Part D will remove the infamous “donut hole” and establish a new hard limit of $2,000 per year on Part D drug spending.

“The The Inflation Reduction Act aims to improve Medicare benefits by reducing out-of-pocket costs for prescription drugs.” Kanwar Kelley, MD, JDexplained co-founder and CEO of Side Health Medical news today. “This is done by shrinking the ‘doughnut hole’ for prescription drug coverage. The ‘doughnut hole’ refers to the gap between a plan’s initial coverage of prescription drugs through co-pays or coinsurance and the point at which a person meets catastrophic coverage limits where Medicare resumes cost-sharing.”

Part D basic premium to increase

Another change from 2025 that affects Medicare Part D is an expected increase in the base premium.

“The Centers for Medicare and Medicaid Services (CMS) has now limited the amount that companies are allowed to increase their annual premiums to 6%,” Ramsey noted. “The the basic beneficiary’s premium will be $36.78, which is $2.08 more than 2024 and a maximum increase of 6%.”

According to Tim Smolen, Statewide Health Insurance Benefits Advisors (SHIBA) program manager in the Consumer Protection Division of the Washington State Office of the Insurance Commissioner, said the best way to learn more about Part D base premium increases is to use plan search tool on the Medicare website. Smolen added:

Reduction in stand-alone Part D plans

There will also be a reduction in the number of stand-alone Medicare Part D plans available, according to KFFa non-profit organization focused on health policy.

“In 2025, 524 PDPs (prescription drug plans) will be offered in the 34 PDP regions nationwide, which is a 26% decrease from 2024,” Ramsey said. “This means the average beneficiary in each state will have a choice of at least 12 stand-alone drug plans. This could mean a change in formularies, pharmacy networks on plans and whether your plan has a deductible in 2025.”

“There will be a reduction in prescription drug plans under Part D, but this reduction may streamline the options in favor of more plans with the built-in price stabilization feature,” Kelley said. “So while fewer plans will be available, they should be more cost-effective.”

Expansion of mental health care and nursing staff resources

And the last major change affecting Medicare in 2025 is an expansion of mental health and nursing staff resources.

“Elder care is a tremendous source of financial burden and stress for families,” Kelley said. “Additional financial support will help reduce that burden and give back time to those looking for carers for people with dementia. This will also allow more individuals to age in place, reducing the need for costly institutional care.”

“Mental health issues for older adults is something we all need to talk about more,” Smolen said. “Check in and ask how the elderly and people with disabilities are doing. They need to know you care. There are also supports and treatment that Medicare pays for – including some telehealth. There are covered drug treatments. And there is also counseling support.”

“More people need some support to live independently and safely in their homes and we need to make that possible,” he added. “Look up a local agency on aging in the area Finder for elder care resources.”

See the original article at Medical news today