As the Medicare program continues to change in 2025, Maryland's beneficiaries have new information to consider when planning their coverage. Fortunately, Maryland offers unique options that can help beneficiaries maximize their benefits and receive fitting care, whether they're new to Medicare or experienced beneficiaries evaluating their current plans. Here are things Maryland Medicare beneficiaries should know for 2025.
Medicare is a federal health insurance program mostly for people aged 65 and older, and some younger people with qualifying disabilities or health conditions. It consists of four main parts: Part A (hospital stay coverage), Part B (medical coverage), Part C (Medicare Advantage, an alternative to Original Medicare through private insurers), and Part D (prescription medication coverage).
Enrollment periods are key for signing up or making changes to coverage. For example, the Initial Enrollment Period (IEP) begins three months before the month of an individual’s 65th birthday and lasts seven months. The Annual Enrollment Period (AEP), from October 15 to December 7 each year, allows changes to Part C and Part D plans. The AEP is an important enrollment period each year, so, preparing for the 2025 Medicare annual election period is a must.
Each year, the Centers for Medicare & Medicaid Services (CMS) updates Medicare plans, impacting premiums, deductibles, and coverage options. Maryland beneficiaries can benefit from keeping track of these updates to ensure their coverage meets their needs in 2025.
Several important changes to Medicare will take effect in 2025. These changes are designed to improve affordability and accessibility.
Reduced Prescription Drug Costs
Medicare Part D beneficiaries will see an improvement in drug affordability due to the Inflation Reduction Act (IRA), passed in 2022. Starting in 2025, the IRA will cap out-of-pocket Part D costs at $2,000 annually for all beneficiaries. The $2,000 cap only applies to medications included in your Part D coverage. This change will hopefully provide some financial relief, especially for those with chronic conditions requiring multiple medications.
The IRA will also introduce a new Part D payment plan option for Medicare beneficiaries in 2025. This option does not lower medication costs but can help some people manage their expenses more easily.
When someone signs up for this payment plan, they will receive a monthly bill for their medications rather than paying upfront at the pharmacy. This option can be useful for some, but not all. If you have a lot of medication costs at the beginning of the year, this payment option may be useful.
Medicare Advantage (MA) plans are an alternative to Original Medicare, typically offering additional benefits and sometimes lower premiums. In Maryland, the availability and variety of Medicare Advantage plans have grown, with several changes for beneficiaries to consider in 202
HMO (Health Maintenance Organization) plans in Maryland offer potentially lower costs for Medicare beneficiaries who use a network of providers and select a primary care physician to coordinate care. These plans can include extra benefits like dental and vision but require in-network care, which can be cost-effective for those comfortable with limited provider choices.
PPO (Preferred Provider Organization) Medicare Advantage plans in Maryland provide more flexibility, allowing beneficiaries to see in-network and out-of-network providers without referrals. While in-network care costs less, out-of-network services are also covered at higher rates, making PPOs ideal for those who prefer broader provider access.
Medigap plans, also known as Medicare Supplement plans, help cover out-of-pocket costs not covered by Original Medicare, including deductibles, copays, and coinsurance. Maryland beneficiaries considering Medigap in 2025 should keep the following points in mind.
Medigap plans are standardized in Maryland, meaning the benefits within each plan letter (A, B, C, etc.) are the same regardless of the insurance carrier. However, premiums vary based on different factors, so it's beneficial to compare prices across different carriers.
Maryland residents should aim to enroll in a Medigap plan during their Medigap Open Enrollment Period, which takes place six months from their Medicare Part B effective date. During this time, Medigap insurers cannot use medical underwriting to determine premiums or deny coverage based on pre-existing conditions.
In most states, this is usually one of the only times someone can enroll in a Medigap plan without underwriting. Fortunately, in Maryland, Medicare beneficiaries have an additional Open Enrollment Period each year around their birthday. During this enrollment period, Maryland residents can switch to a different Medigap plan with equal or lesser value without underwriting.
For retirees who travel frequently or live seasonally in different states, Medigap offers flexibility as it covers out-of-state healthcare providers. This can be an important consideration for Maryland beneficiaries who have part-time residency elsewhere as well.
As Medicare continues to change, beneficiaries in Maryland will want to stay updated on new developments that may affect them. With new rules and benefits, such as the Part D out-of-pocket cap and new payment plan option, Maryland residents can look forward to improved coverage for their healthcare needs.
By reviewing plan options and considering personal healthcare needs, Maryland Medicare beneficiaries can maximize their coverage in 2025 and more.
