Reminders to Help Medicare Beneficiaries Prepare for 2025
As 2025 approaches, it is important for Medicare beneficiaries to prepare for the new plan year. Below, we share a few key reminders to help with this process.
Special Enrollment Period for Plan Non-Renewal
If a Medicare Advantage or Part D plan does not renew its contract with Medicare for services in a specific area, affected beneficiaries should have been notified by October 1, 2024. These individuals are granted a Special Enrollment Period (SEP) to switch to another Medicare Advantage or Part D plan. This SEP runs from December 8, 2024, through February 28, 2025.
The effective date of new coverage depends on the timing of enrollment:
- Enroll by December 31: Coverage begins January 1.
- Enroll in January or February: Coverage starts the first day of the following month.
Programs that Help with Medicare Costs
Beneficiaries who need help affording their Medicare coverage may have options available to help reduce their costs. Namely, the Medicare Savings Program (MSP) is available to help people pay their monthly Medicare premiums, and Extra Help is available to lower people’s Medicare Part D (prescription drug) costs. Medicare recently announced the 2025 resource limits for both MSP and Extra Help. More information on each program is below:
Medicare Savings Programs (MSP)
In mid-November, the federal government announced the 2025 resource limits for the Medicare Savings Programs that help people pay Medicare premiums. Most people enrolled in these programs get help with their Medicare Part B premium. Some people also get help with other Medicare cost-sharing, such as Part A and B deductibles and coinsurance, if they meet certain income limits. In Pennsylvania, the Medicare Savings Programs are also known as the Medicare “buy-in” programs.
Starting January 1, 2025, the new resource limits will be $9,660 (single) and $14,470 (married couple). The 2024 resource limits are $9,430 (single) and $14,130 (married). Read PHLP's 2024 MSP facts sheet here, and stay tuned for the 2025 version of this fact sheet, which will be available once the Federal Poverty Guidelines are released in early 2025.
Extra Help
Starting January 1, 2025, the resource limits for Extra Help with Medicare Prescription Drug Costs (also called the Low-Income Subsidy or “LIS”) will also increase. The Extra Help program lowers people’s Medicare Part D costs. The new resource limits for 2025 are as follows:
- Single: $17,600
- Married: $35,130
The above limits include a $1,500 per person disregard that is given when applicants indicate on their Extra Help application that they expect to use some of their resources for funeral or burial expenses. People with Extra Help will pay the following costs in 2025:
- Premium: 100% premium subsidy up to $48.36 for basic coverage
- Deductible: $0
- Catastrophic coverage: $0
- Initial coverage period:
- $0 if receiving Medicaid Long Term Care (HCBS Waiver or Nursing Home)
- $1.60 generic/$4.80 brand name if income is under 100% of the Federal Poverty Level (FPL) AND getting full Medicaid
- $4.90 generic/$12.15 brand name if income is above 100% of the FPL
Extra Help works with any Part D plan. See PHLP's 2024 Extra Help fact sheet here and stay tuned for the 2025 version of this fact sheet, which will be available once the Federal Poverty Guidelines are released in early 2025.
Individuals who need help applying for the Medicare Savings Programs or the Extra Help program are encouraged to call PA MEDI at 1-800-783-7067.
Special Enrollment Period for People Losing Extra Help
Beneficiaries whose Extra Help benefits are terminated at the end of the year are eligible for a one-time Special Enrollment Period (SEP) to disenroll from or switch their Medicare Advantage or Part D plan. This SEP lasts for three months from either the date of ineligibility or the date of notification of ineligibility, whichever is later.
Beneficiaries uncertain about their Extra Help status can verify it by calling 1-800-Medicare or logging into their personalized account on Medicare.gov.
Applications for Extra Help benefits can be submitted at any time by contacting Social Security at 1-800-772-1213 or visiting SSA.gov. For more information on eligibility guidelines, click here. For more information about Special Enrollment Periods, click here.
What to Do with Prescription Drug Coverage Issues After Enrolling in a New Plan or Changing Plans
In certain circumstances, Medicare Advantage Plans and Part D Plans are required to provide a transition refill for new plan participants. Transition refills offer temporary coverage for medications that are not included in the plan’s formulary or are subject to restrictions such as prior authorization or step therapy requirements.
Beneficiaries are eligible for a one-time, 30-day supply of a medication within the first 90 days of enrollment under either of the following circumstances:
- When switching to a new Part D or Medicare Advantage Plan; or
- When an existing plan changes its coverage at the start of a new calendar year.
Along with the transition supply, plans must issue a notice explaining that the refill is temporary. The notice will include information about appeal rights and guidance on next steps, such as switching to a covered drug or filing an exception request with the plan.
Help is Available!
Medicare beneficiaries can contact Pennsylvania Medicare Education and Decision Insight, PA MEDI for free, unbiased help with their Medicare questions. PA MEDI does NOT sell or recommend Medicare insurance products, insurance agents, or brokers. The PA MEDI Helpline can be reached Monday to Friday from 8am to 5pm at 1-800-783-7067.
