Medicare Annual Enrollment Period 2025

Introduction | Medicare AEP Explained | ANOC | What Changes Can I Make? | Part D Plans | Part D IRA Changes | Medicare Advantage Plans | Switching Out Of Medicare Advantage | Medicare Advantage IRA Changes | Medicare Supplements | What's Best For Me

Jo Gallo

Licensed Life and

Health Insurance Broker

Written 5/26/2023

Medicare Annual Enrollment 2025

Intro | Should I Take Medicare Now?

|How To Signup For Medicare | Medicare Secondary Options |

I'm Turning 65 But My Spouse Is Not |

Medicare Disability | Medicaid

"Really I would give Jo more stars if I could!"

Schedule Your Free Medicare Education Today!

Schedule Education

Introduction

If you are a Medicare enrollee, the Annual Enrollment Period (AEP) is an important time. From October 15th to December 7th each year, you can assess the changes to your Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan (Part C) and see if it makes sense to switch based on your needs.

This upcoming AEP is even more important than past ones, due to the Inflation Reduction Act (IRA), which made some changes to Medicare’s drug coverage for 2025.

Let’s discuss what you can do during AEP and how the IRA may impact plan changes this year

Medicare AEP Explained

Medicare’s Annual Enrollment Period is the time each year when Medicare enrollees can switch certain types of Medicare plans. It takes place from October 15th through December 7th every year, and plan changes take effect January 1st.

Annual Notice of Changes

The insurance carriers send out their Annual Notice of Changes (ANOC) to members in September, and these ANOC’s outline the specific changes to each Part D or Advantage plan for the new year. Members must thoroughly review these changes to see if switching their policies is necessary.

What Changes Can I Make During Medicare AEP?

Depending on your situation and the state you live in, there are many changes you can make during Medicare AEP. These generally include:

Switching your standalone Part D drug plan
Switching your Medicare Advantage plan
Switching from Medicare Advantage to Original Medicare
Switching from Original Medicare to Medicare Advantage

Let’s dive into what to look for in each of these situations.

But first... please note: You can switch your Medicare Supplement (Medigap coverage) this time of year too. But in most cases, you can switch your Medicare Supplement at any point throughout the year if you qualify. The focus and urgency surrounding AEP relates to Part D plans and switching Medicare Advantage plans or switching between Medicare Advantage and Original Medicare.

Standalone Part D Plans

If you have a standalone Part D plan, be sure to read your Annual Notice of Changes in September. Your ANOC will alert you to any potential changes to your plan’s premium, in addition to outlining any changes to the formulary (their list of covered drugs) and cost sharing for each covered prescription.

If your current plan no longer covers your prescriptions favorably, it may make sense to switch. You can switch to a new standalone Part D plan available in your area between October 15th through December 7th. Your new policy will start on January 1st of the following year, and you will be automatically disenrolled from your current plan.

Part D Changes Due to the Inflation Reduction Act

The Inflation Reduction Act is making 3 major changes to Part D plans in 2025. They are:

No more coverage gap (otherwise known as the donut hole)
A $2000 Out of Pocket Maximum for Part D Enrollees
Ability to pay RX annual out of pocket costs in monthly installments

While we are not sure of all of the changes to come to Part D due to the Inflation Reduction Act, we are anticipating the following:

Increased monthly premiums on your Part D Plan
Changes to plan formularies/covered medications
Changes to RX copays

It is important that you read your Annual Notice of Changes to see if your plan still suits your needs.

Medicare Advantage Plans

If you have a Medicare Advantage plan, start by reading your Annual Notice of Changes in September. Your ANOC will outline the changes to your plan’s premium, formulary (list of covered drugs), hospital and medical benefits, ancillary benefits like dental and vision, and more. You will also want to confirm with your doctors that they are working with your insurance carrier in the upcoming year.

If your current plan no longer covers your prescriptions favorably, it may make sense to switch. You can switch to a new Medicare Advantage plan available in your area between October 15th through December 7th. Your new policy will start on January 1st of the following year.

Switching From Medicare Advantage to Original Medicare

If you would like to move from Medicare Advantage to Original Medicare, you can do so during AEP! If you enroll in a standalone Medicare Part D plan between October 15th and December 7th, you automatically will be disenrolled from your Medicare Advantage plan at the end of the year. Your Original Medicare will start on January 1st of the following year (in this case, Jan 1, 2025).

If you plan to switch back to Original Medicare, we recommend you enroll in a Medicare Supplement too. In most states, Medicare Supplements require underwriting. This is the process of an insurance company determining if you are healthy enough to enroll into their plan (or not). We recommend that you confirm your acceptance and enrollment into a Medicare Supplement before you enroll in a Part D plan.

Medicare Advantage Changes

Due to the Inflation Reduction Act and changing market conditions, Medicare Advantage appears to be on the brink of big changes in 2025. The Inflation Reduction Act guarantees a few things for Medicare Advantage plans, including:

No more coverage gap (otherwise known as the donut hole)
A $2000 Out of Pocket Maximum for Part D Enrollees
Ability to pay Rx annual out of pocket costs in monthly installments

While nothing is yet set in stone, we also are anticipating:

Increased monthly premiums
Changes to plan formularies/covered medications
Changes to Rx copays
Fewer ancillary benefits such as dental, vision, OTC cards, etc.
Changes to provider networks

You must very thoroughly scrutinize your Annual Notice of Changes this year to see if your Medicare Advantage plan is still right for your needs. It may make sense to consider switching plans or switching to Original Medicare.

Medicare Supplements

Contrary to popular belief, in most cases, Medicare Supplements are not tied to the Medicare Annual Enrollment Period. That’s because in most states, Medicare Supplements may be switched all throughout the year provided you pass underwriting. Underwriting is when an insurance company determines if you are healthy enough to switch into their plan.

If you have minimal to no health issues and no upcoming surgeries or diagnostic tests, you are more likely to pass underwriting. If you have more severe chronic conditions or have had a major health event like cancer or heart attack in the last 2 years, you may not be able to. Each company has its own standards, so it’s important to talk to our brokers to see if there is a company that will accept you.

Switching From Original Medicare to Medicare Advantage

If you want to switch from Original Medicare to a Medicare Advantage plan, you can do so during Medicare AEP! You can enroll in a Medicare Advantage plan available in your area from October 15th through December 7th, and your plan will start on January 1st of the following year. You automatically will be disenrolled from Original Medicare and any standalone Part D plan you are enrolled in. If you are enrolled in a Medicare Supplement as well, you will need to proactively inform them of your disenrollment at the end of the year.

What Is Best For Me?

The Medicare Annual Enrollment Period is a confusing process for anyone, and it will only be more so in 2024. The combination of the Inflation Reduction Act and changing market conditions will lead to potentially increased costs and changes to benefits across the industry.

Start by looking through your Annual Notice of Changes to see if your plans still cover your needs. Then speak with the brokers at NJ Life and Health to see what your options are if you’d like to switch. We treat our clients with respect and care and give you a fulsome evaluation of all your options in plain English.

Schedule a no cost educational/informative appointment for yourself with one of our licensed brokers by visiting our website at www.njlifeandhealth.com or call our Toms River, NJ office at 848-226-6897.