October 17, 2024
Medicare open enrollment for 2025 began on October 15! The Medicare program is changing more than it has since 2006, so it’s especially important to understand your Medicare plan’s benefits, compare options, and make sure you have a plan that works best for your healthcare needs and budget.
Key Takeaways
Key Takeaways
Open Enrollment
The window to make changes to your Medicare coverage plan is open from October 15th to December 7th.
Compare Plans
Compare your Medicare Advantage (MA) or Part D prescription drug plans—you might save money!
Prescription Costs
You may have lower out-of-pocket prescription costs in 2025 and can spread them throughout the year.
What is Medicare open enrollment?
Medicare open enrollment is the period during which someone with a Medicare plan can make changes to their health plan or prescription drug plan for the next calendar year. Open enrollment occurs from October 15th through December 7th annually. Any changes you make to your health plan or drug plan will take effect on January 1, 2025.
Capped Out-of-Pocket Spending
New policies limit the maximum amount you must pay out of pocket to cover drugs.
If you get drug coverage through Medicare Part D, you will not pay more than $2,000 in 2025 out-of-pocket for drugs.
This includes your deductible (the amount you pay before your prescription drug plan starts coverage), copays, or coinsurance (the amount you pay from your pocket at the pharmacy). Your premium (the monthly cost for your plan) does not count against the $2,000 cap nor do the costs of drugs that aren’t covered by your plan.
Capped Monthly Prescription Drug Costs
Beginning in 2025, your Part D plan must offer the option to “smooth” out your drug payments over the year.
The Medicare Prescription Payment Plan gives patients the ability to spread prescription payments over the year.
If you’ve ever experienced stress at the pharmacy counter from having to pay a significant amount of money out of pocket all at once, this option might be better for you. Your Part D plan should make it easy to opt-in to the Medicare Prescription Payment Plan. If you want to opt-out at any time during the year, you can.
Greater Availability of Anti-Obesity Drugs
NKF has been working to expand access to anti-obesity medications.
Starting in 2025, more drugs that help protect kidney health will be covered under Part D for those with type 2 diabetes or heart disease.
These drugs (like Ozempic, Mounjaro, and Wegovy) can have very high out-of-pocket costs. Though out-of-pocket drug costs will be capped at $2,000, some may want to spread the cost over the year by enrolling in the Medicare Prescription Payment Plan through your Part D plan.
Learn how NKF kidney advocates backed a bill to help people manage their weight.
Capped Insulin Costs and Free Vaccines
Medicare has a rule that caps out-of-pocket costs for insulin under Part D at $35 for a month’s supply. Recommended vaccines, like flu shots or shingles vaccines, are also covered with no out-of-pocket costs.
Medicare Part D caps insulin costs at $35 per month and covers all recommended vaccines.
This helps lower healthcare expenses for essential medications and preventive care.
Important Reminders
- It’s especially important to understand if your plan is making changes for 2025 because the $2,000 cap on out-of-pocket spending might have a ripple effect on other costs in your plan.
- Make sure to check your Part D plan whether you have what is called a standalone Part D plan or if you get your prescription drug benefits through your Medicare Advantage plan.
- Check your premium, deductible, and what your plan covers, including the drugs you take and the providers you see, to make sure your current plan is best for you in 2025. Some Part D premiums will stay the same from 2024 to 2025, but many plans’ premiums will increase or decrease.
Mid-Year Statement from Medicare Advantage
Many kidney patients are enrolled in Medicare Advantage (MA) plans, which can contain lower or no premiums and supplemental benefits such as vision, dental, and hearing benefits. This year, look for a statement in the middle of the year that will tell you which of the benefits you are using and which you aren’t. This might help you better understand the value of the plan you’ve selected and consider whether a different plan might work better.
How do I know if my plan is changing?
If you’re enrolled in Medicare Part D or a Medicare Advantage plan, your plans must make “Annual Notice of Change” and “Evidence of Coverage (EOC)” documents available to you. These documents might have been mailed to you in September or might be in the online portal associated with your plan. If you get your Medicare benefits through traditional Medicare (original Medicare), you’ll have received the 2025 Medicare and You handbook. You can also access your plan documents through your online Medicare account.
Scan your Annual Notice of Change over diving into your Evidence of Coverage, which can be many hundreds of pages long.
If you can’t find these documents or they are overwhelming, you can compare your plan options at Medicare.gov or 1-800-Medicare. You can also contact your state’s State Health Insurance Assistance Program (SHIP) or the Medicare Rights Center.
Get Support with NKF Cares
Speak with a trained professional with NKF's patient information helpline. Call toll-free at 855.NKF.CARES (855.653.2273) or email nkfcares@kidney.org. We speak English and Spanish and are available Monday through Friday from 9:00 am to 7:00 pm Eastern Time.
