Medicare Changes in 2025 will affect everyone on Medicare so don’t get caught off guard! Welcome the new year with confidence as we explore 6 new changes to Medicare.
Welcome 2025! There are BIG changes happening with Medicare this year! We’re breaking down the latest updates to help you manage your health and Medicare insurance benefits with ease. Here are the 6 biggest changes to your Medicare you need to know about:
1. Lower Out-of-Pocket Prescription Drug Costs
As you probably learned during this years’ Medicare Annual Election Period, there is now a $2,000 out-of-pocket limit and a simpler 3-phase process for Medicare Part D costs (bye-bye donut hole!). These changes apply to anyone with a Part D drug plan or a Medicare Advantage plan that includes prescription drugs. Get all the details in our article: Medicare Part D Changes 2025: Lower Costs, Simplified Coverage but Maybe Higher Premiums.
2. New Medicare Prescription Payment Plan
Starting in 2025, there’s a new way to manage your prescription drug costs with Medicare. This new payment option works alongside your existing drug coverage, allowing you to spread your out-of-pocket costs throughout the year (from January to December). For more details, check out our article, What is the Medicare Prescription Payment Plan?
3. Expanded Mental Health and Wellbeing Coverage
Medicare is expanding its mental health coverage, making it easier to get the support you need in 2025. This includes things like intensive outpatient programs (in some places) and services from marriage and family therapists, as well as mental health counselors.
During your yearly wellness visit, your doctor might ask you some questions to understand your overall well-being. This helps them connect you with helpful resources free of charge! It’s called a “social determinants of health risk assessment”. Your provider will also assess your cognitive health to check for signs of dementia, including Alzheimer’s disease. If they find any signs of memory issues or difficulty concentrating, they may recommend additional testing and care plans. They’ll evaluate your risk for substance use disorders and offer support, including reviewing your opioid treatment plan and referring you to specialists if needed.
Medicare covers a range of mental health services, from counseling and therapy for things like depression and anxiety to visits with psychiatrists, psychologists, social workers, and more. These services can take place in one-on-one, group, or family setting. This also includes structured day programs (partial hospitalization) and intensive outpatient programs offered at various locations. Medicare also permanently expanded access to telemedicine for many behavioral health services.
4. Reduced Medicare Telehealth Coverage
On January 1, 2025, many of the telehealth services that were offered during the COVID pandemic ended. Moving forward, you’ll generally need live in a rural area to access certain Telehealth services. Fortunately, there are some important exceptions! You can still get the following telehealth services no matter where you are:
- Monthly check-ins for kidney dialysis at home.
- Stroke care (even in a mobile stroke unit!).
- Treatment for substance use or mental health issues (including at home).
- Behavioral health services (also at home).
- Diabetes self-management training.
- Nutrition therapy.
Costs will generally match what you’d pay for in-person visits. For these services, you’ll pay 20% of the Medicare-approved rate, and the Part B deductible applies. Just a reminder that Medigap insurance can cover the 20% part. Want to see how much a plan might cost you? Click here and get an free instant online Medigap quote.
5. Support for Caregivers Training
Medicare now covers caregiver training to help your caregiver learn essential skills like giving medications or providing personalized care. If your doctor recommends it as part of your treatment plan, your caregiver can attend training sessions—either individually or in a group—without you needing to be there. The training focuses on your specific health needs, and you’ll pay 20% of the Medicare-approved cost. Once again if you have a Medigap plan it should cover the 20% portion. The Part B deductible also applies. Learn more here
6. Enhanced Dementia Support
If you’re caring for someone with dementia, or living with it yourself, you might qualify for extra support through the Guiding an Improved Dementia Experience (GUIDE) Model pilot program. This expanded new program offers a support line, tools to find community-based assistance and medical services, and $2,500 a year for at-home, overnight or adult day care services. See details here.
Now that you have a better understanding of Medicare’s 2025 changes, you may want to make sure you have a Medigap plan to complement your coverage. Give us a call here at Senior65 if you need assistance (800-930-7956)