Each fall, during the Open Enrollment Period (OEP) from October 15th to December 7th, Medicare beneficiaries have the chance to switch to a new Medicare drug plan or Medicare Advantage plan for the following year.
In 2025, there are many changes (including cancellations and new plans) with both Medicare drug and advantage plans. With all these changes it more important than ever this year to complete a plan comparison to understand your options during Open Enrollment.
What changes are being made to your plan next year?
Many Medicare drug plans and Medicare Advantage plans are continuing their coverage without interruption next year. But, even if your current plan will still be offered in 2025, there could be significant changes made including removing prescriptions from the plan’s formulary (the list of covered drugs).
Every September you will receive an Annual Notice of Change (ANOC) from your current plan. If you don’t receive your ANOC by September 30, you should contact your plan right away to request it. The ANOC will tell you about any changes to your plan for the next year. When reviewing your ANOC, you should pay special attention to changes to:
- the monthly plan premium,
- the plan deductible,
- copayment or coinsurance changes,
- prescriptions covered by the plan,
- what pharmacies are preferred (provide lower pricing),
- and if you are in a Medicare Advantage plan the network of providers.
Understanding these changes will allow you to make an informed decision about whether a plan change makes sense for you.
Is your current plan being canceled next year?
Several plans in Iowa are being cancelled at the end of 2024. If your plan is being canceled, you should have received a letter from your plan in October. During the Open Enrollment, you will need to make some decisions based on the type of plan being canceled.
- If your Part D plan was canceled: You will need to choose a different Part D plan for 2025. Check that your prescriptions are covered by the new plan and that your pharmacies are preferred (or in network).
- If your Medicare Advantage plan was canceled: You will need to decide if you want to enroll in a different Medicare Advantage plan for 2025 or if you want to return to Original Medicare with the opportunity for a Medicare supplement with a “guarantee issue” (a “guarantee issue” means that, if you are 65 and older, you can choose any Medicare supplement without being denied or charged a higher monthly premium due to your health). In this case, you have until February 28, 2025, to make a final decision. It is important to understand that your current coverage will end on December 31st, 2024. If you do not decide by that date, you could have a gap in your healthcare coverage.
Is your current plan being crosswalked next year?
Some Part D plans and Medicare Advantage plans crosswalk their members, meaning they discontinue the plan you are in this year and automatically move members to a different version of the plan. In this situation, you have two options:
- You can do nothing and accept the crosswalked plan as your coverage for next year. This includes accepting any changes from your current plan to the crosswalk, such as cost, coverage, formulary, or network changes, etc.
- Or you can choose to enroll in a different plan. Anytime you choose a new plan, though, you should check to make sure your prescriptions are covered by the plan and pharmacies are in-network or preferred. For any Medicare Advantage plans, you will want to check with your providers (doctors, hospitals, durable medical equipment providers, etc.) to see which plans they will accept next year.
Is your Medicare Advantage plan in-network with your providers next year?
Whether you are sticking with your current Medicare Advantage (MA) plan or enrolling in a Medicare Advantage plan that is new to you, it is important to consider networks. Check with your providers (doctors, hospitals, durable medical equipment) to see which MA plans they accept. And check with the MA plan to see that your providers are in the plan’s network. With Medicare Advantage plans, if you use a provider who is out-of-network (or who doesn’t accept the MA plan), you could have higher costs or even be responsible for the full cost of a service.
For more details about how Medicare Advantage plan work compared to Original Medicare, see the Medicare Advantage Plans page on our website.
Once Open Enrollment is over, you may have limited options to plans if a drug doesn’t turn out to be covered or if your provider isn’t in-network with a plan, so it is important to make your changes now.
SHIIP-SMP Counselors can help you compare your plan options for 2025. To make an appointment with a local SHIIP-SMP site, call 1-800-351-4664. Or you can call 1-800-MEDICARE for assistance, 24 hours a day, 7 days a week. You can also find resources to run your own plan comparison at https://shiip.iowa.gov/find-resources/medicare-open-enrollment-period.