Medicare, The Good and The Questionable

Medicare in 2025 has made some changes. Some are good, some not so good.

Let’s review them and you can decide.

1. The maximum out-of-pocket for all drugs plans has gone down to $2,000 from the previous year of $8,000. This is both good news and bad news. The good news is the maximum out-of-pocket has been significantly reduced. The bad news is the drug companies are now charging more money for some of their drugs due to less money received. Eventually, this must be addressed before the cost of drugs gets too much higher. We Americans are paying the highest amount of money for drugs than any other country in the world.

2. The Inflation Reduction Act reduced the price of 10 drugs starting in 2026. Why wait until 2026 and why only 10 drugs. It sems to me this is cherry pickling and not very helpful for seniors who take drugs not on that list. One of those drugs is Farxiga which has many uses. Today you pay the deductible of $590 and about 25% of the cost of the medication. That is a lot of money for a senior who is retired and on a fixed income. In 2026 the price is supposed to be $35. A major difference. Why didn’t the price reductions start in 2025? There was plenty of time to do this but Congress (who is not Medicare) decided to commence these savings in 2026 instead. Not a good decision for seniors.

3. The Part B monthly premium has increased to $185.00 per month; a small change of about $10.00 per month. Congress keeps raising this annually. At some point many will not be able to afford the premium. Since Congress is not on Medicare, they don’t care what we must pay monthly. Since I began selling Medicare over 20 years ago the monthly Part B premium has risen from $55.00 per month to $185.00 per month. Where does it end?

4. Medicare Advantage Plans or MAPD plans have made changes as well and not all are good. While most of these plans still have no monthly premium, they are cutting benefits to save money. Over the counter medications, transportation services and in-house support are where some of these cuts have happened.

5. Medicare is now covering more mental health services along with cardiovascular assessments. This is good news for seniors.

6. There is something new for 2025, it’s called Medicare Prescription Payment plan which allows you to pay for your expensive medications over a period instead of paying monthly. I think this is ultimately a disaster waiting to happen. If someone cannot afford their drugs now, having a payment plan simply moves the payments down the road. Eventually, you still must pay for the medications. A much better approach would be to force the drug manufactures to sell their drugs in the US for the same price they sell then elsewhere in the world. Americans pay the highest drug costs in the world and Congress allows this to happen. This has been an issue that I am very interested in as I believe Big Pharma has been over charging Americans for drugs for many years. Drug companies pay little or no federal income taxes because the write off those developmental expenses against earnings. Congress refuses to review this because Big Pharma provides campaign contributions to most of Congress. This one issue alone would reduce the costs of drugs for everyone in America and is a big deal.

7. Mid-Year Reminder of unused benefits. Those on MAPD plans will get notice mid-year of unused benefits which is supposed to encourage you to use them. This might help people to utilize their MAPD plan more and perhaps stay healthier.

8. Financial incentives for brokers and agents. Apparently, many of the MAPD plans nationwide have been offering brokers and agents additional commissions to sell their product. I personally have never seen it here in Nevada nor have I been offered any additional incentives, but it is happening across the country. CMS has finally stopped this nonsense and will force those companies engaging in this practice to stop or probably lose their Medicare contract. That is a very strong incentive to stop this practice, and I suspect it will cease soon.

These are the highlights of changes to Medicare for 2025. Expect more changes in the future. Assume this information was helpful for those on Medicare and not familiar with what is happening.

I hope this information is useful and if anyone has questions, please contact me via phone or email and I will respond quickly.

Also, take a look at Medicare 2025 Information.

The Barend Agency Inc.

Len Barend, Broker

Cell:702-250-2200
Email: len@insurance4unevada.com