Medicare Open Enrollment Ends December 7th: Review Your Coverage and Make Changes Now
Medicare’s Annual Open Enrollment Period started October 15th and runs through December 7th. During this period, all Medicare beneficiaries can make changes to their health or drug plan coverage. Changes made during this period start January 1, 2025.
Medicare beneficiaries should review their current plan now to ensure it will still meet their needs for the upcoming year. PA MEDI staff and volunteers are available to assist residents across Pennsylvania in exploring their 2025 Medicare coverage options. Those needing help reviewing their plan options can call PA MEDI’s statewide helpline at 1-800-783-7067 to connect with their local program.
Below are details about 2025 Medicare plan offerings as well as other important updates and reminders for those seeking to make plan changes for next year.
Available Plans in 2025
Stand-Alone Medicare Prescription Drug Plans
In Pennsylvania, there will be 14 stand-alone prescription drug plans available for enrollment in 2025. Premiums for these plans range from $0 to $168.20 per month. In 2025, there are only two zero-premium plans for individuals who qualify for Extra Help: SilverScript Choice and WellCare Classic. Download more information about the 2025 zero-premium plans here.
Notably, Cigna will not offer a zero-premium plan next year, meaning those receiving Extra Help who currently have Cigna will need to switch to another provider to avoid a $16.04 monthly premium for their Part D coverage starting in January. Additionally, AARP will also discontinue its zero-premium plan next year, requiring individuals receiving Extra Help who are with AARP to find a new plan to avoid a $15.64 monthly premium.
Medicare Advantage Plans
Residents across all counties in Pennsylvania have a wide selection of Medicare Advantage plans available to them. The numbers of plans available varies by county, ranging from the 39 plans available to residents in Pike County to 85 plans in Dauphin County. This doesn't include Medicare Special Needs Plans, which are designed for specific groups of beneficiaries, such as dual eligibles, individuals in nursing homes, and those with certain chronic conditions like diabetes or cardiovascular disease.
Most, though not all, Medicare Advantage plans include drug coverage. Individuals considering a Medicare Advantage plan for 2025 should review the plan’s costs, benefits, provider network, pharmacy network, list of covered drugs, and any additional benefits, such as dental or vision care, or Special Supplemental Benefits for the Chronically Ill (SSBCI). Keep in mind that SSBCI benefits are not guaranteed, and eligibility will only be determined after enrollment in the plan. For more information about 2025 plan offerings and benefits, visit www.medicare.gov.
Medicare Special Needs Plans for Dual Eligibles (D-SNPs)
These plans only enroll Medicare beneficiaries who also have Medicaid – people who fall into this group are called dual eligibles. D-SNP offerings have continued to expand and are widely available in every county in Pennsylvania.
It is important to remember that the D-SNP only provides the member with their Medicare coverage and the person still has Medicaid as separate insurance coverage that generally pays second to Medicare. In 2025, all counties in Pennsylvania will have at least eight D-SNPs available; some have as many as nineteen. Many of the available D-SNPs require that someone have full Medicaid to enroll, but some of the plans do allow “partial duals” to enroll. Partial duals are those who receive limited help from Medicaid through the Medicare Savings Programs, including Qualified Medicare Beneficiaries (QMBs). QMBs get Medicare cost-sharing benefits as well as help with their Medicare Part B and Part A (if any) premiums. Partial duals interested in enrolling in a D-SNP should contact the plan to see if they qualify and to learn more about their costs.
Updates & Reminders
Medicare Prescription Payment Plan
Starting in 2025, individuals with a Medicare Part D Plan or a Medicare Advantage Plan that includes drug coverage will have the opportunity to enroll in a new voluntary program called the Medicare Prescription Payment Plan (MPPP).
This program is designed to assist beneficiaries with high out-of-pocket drug costs by allowing them to spread these expenses throughout the calendar year.
It’s important to note that the MPPP does not lower drug costs or save money for beneficiaries. Those who are likely to benefit the most are individuals facing high drug costs at the start of the year. For detailed information on how monthly payments will be calculated under the MPPP, beneficiaries can use the Plan Finder at www.medicare.gov.
While all Medicare beneficiaries with Part D coverage can participate, it is advisable for individuals to check their eligibility for the Extra Help Program and/or PACE/PACENET before considering the MPPP. The MPPP may not be the best choice for those who currently receive Extra Help, are enrolled in PACE/PACENET, or have low drug costs. These individuals are discouraged from enrolling in the Medicare Prescription Payment Plan.
Medicare Part D Out-of-Pocket Cap on Spending
Starting in 2025, out-of-pocket costs for Medicare Part D prescription drugs will be capped at $2,000. Beneficiaries who reach this cap during the plan year will not have to pay any costs beyond that amount. This marks the most significant change to Medicare Part D since it began in 2006. As part of the Inflation Reduction Act, this new cap is expected to reduce annual out-of-pocket spending for Medicare Part D enrollees by approximately $7.4 billion.
Medicare Plan Finder Tool
Medicare.gov's Plan Finder Tool is an excellent and easy way to find and compare the available Medicare health plans as well as prescription drug plans. By creating an account, Medicare beneficiaries can even see personalized details about their current coverage, Extra Help status, and what they would pay for prescriptions under each plan. Additionally, beneficiaries can enter their prescription drugs and preferred pharmacies into the tool to find out what their costs would be under each plan in their zip code. An email address is not required to set up an account.
