Key Takeaways
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Medicare Advantage plans in 2025 have changed significantly, including a new out-of-pocket cap for prescription drugs and shifting plan benefits.
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You should review your Annual Notice of Change (ANOC) and compare plan details to ensure your current coverage still meets your needs.
Medicare Advantage Is Evolving—Here’s What You Need to Know
Every year, Medicare Advantage plans update their coverage, costs, and benefits. In 2025, several important changes could impact what you pay and the services you receive. Whether you’re already enrolled in a Medicare Advantage plan or considering switching, understanding these changes can help you make informed choices about your healthcare.
Let’s break down the five biggest updates for 2025 that you should be aware of and what they mean for you.
1. A New $2,000 Out-of-Pocket Cap for Prescription Drugs
One of the most significant changes in 2025 is the introduction of a $2,000 annual out-of-pocket cap for prescription drug costs under Medicare Part D. This applies to beneficiaries enrolled in standalone Part D plans as well as those in Medicare Advantage plans that include drug coverage.
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This new cap eliminates the coverage gap (previously known as the “donut hole”), ensuring that once you spend $2,000 on covered medications, your plan covers the rest for the year.
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It offers financial relief for those who take high-cost medications, reducing unexpected expenses.
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If you reach this limit, you no longer pay coinsurance or copayments for covered prescriptions for the rest of the year.
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This new policy helps make prescription drug costs more predictable and removes the risk of unexpected expenses later in the year.
What This Means for You
If you rely on prescription drugs, this change can significantly reduce your financial burden. However, it’s essential to verify whether your medications are covered under your plan’s formulary. Formularies can change, so reviewing your plan each year is crucial.
2. Mid-Year Notifications for Unused Benefits
Starting in 2025, Medicare Advantage plans must send mid-year notifications to enrollees detailing any unused supplemental benefits. This change aims to ensure that beneficiaries fully utilize the benefits included in their plan.
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Between June 30 and July 31, 2025, you’ll receive a personalized notification listing any supplemental benefits you haven’t used yet, such as dental, vision, hearing, or fitness programs.
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This allows you to take advantage of benefits you may have forgotten about before they expire at the end of the year.
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Reviewing this notification can help you maximize the value of your plan and avoid missing out on services you’re entitled to.
Why This Matters
Many Medicare Advantage enrollees don’t use all the benefits available to them. If your plan includes dental, vision, or hearing coverage, be sure to schedule appointments before the year ends so you don’t lose access to these services.
3. Fewer Plans Offering Over-the-Counter and Transportation Benefits
While many Medicare Advantage plans include extra perks like over-the-counter allowances and transportation services, these benefits have become less common in 2025.
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The percentage of plans offering over-the-counter benefits has dropped from 85% in 2024 to 73% in 2025.
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Transportation benefits, which cover rides to medical appointments, have also decreased from 36% in 2024 to 30% in 2025.
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If these benefits are important to you, carefully review your plan’s details or explore other options during the Medicare Open Enrollment Period (October 15 – December 7) to find a plan that still includes them.
What You Should Do
If you rely on over-the-counter allowances or transportation services, verify whether your plan still covers these benefits. If not, you may need to explore alternative options, such as Medicaid or local transportation assistance programs.
4. Potential Changes in Medicare Advantage Premiums and Cost-Sharing
Medicare Advantage premiums and out-of-pocket costs vary by plan and location, but 2025 has seen some general shifts:
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Premiums remain stable for most enrollees, but some plans have adjusted their cost-sharing structures.
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Copayments and coinsurance for certain services may have changed, so it’s crucial to check your plan’s Summary of Benefits.
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Out-of-pocket maximums for Medicare Advantage plans have been adjusted. In 2025, the maximum out-of-pocket limit is $9,350 for in-network services and $14,000 for combined in-network and out-of-network services.
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Some plans have modified their coverage for specialist visits, durable medical equipment, and hospital stays, so reviewing cost-sharing changes is essential.
How to Prepare
To avoid unexpected expenses, carefully review your plan’s Summary of Benefits. If your out-of-pocket costs are increasing, consider switching to a plan with lower cost-sharing.
5. More Changes to Plan Offerings and Provider Networks
Every year, Medicare Advantage plans update their provider networks and make changes to which doctors, hospitals, and pharmacies are covered.
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Some plans have narrowed their networks, meaning that a provider you’ve been seeing may no longer be covered in 2025.
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Certain plans have expanded their network to include new specialists and healthcare facilities.
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If you have a preferred doctor or hospital, verify their participation in your plan’s network to avoid surprise bills.
Steps to Take
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Call your doctor’s office to confirm they’re still in-network.
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Check if your preferred pharmacy is still covered under your Medicare Advantage plan.
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If your provider is no longer covered, explore switching plans during Open Enrollment.
How to Make Sure Your Plan Still Meets Your Needs
With all these changes, you may be wondering what steps you should take to ensure your Medicare Advantage plan still fits your healthcare needs. Here’s what you can do:
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Review Your Annual Notice of Change (ANOC) – This document, sent every September, outlines any changes to your current plan’s costs and coverage.
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Compare Plans During Open Enrollment – If your plan’s benefits have changed in a way that doesn’t work for you, you can explore other Medicare Advantage options between October 15 and December 7.
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Check Provider and Drug Coverage – Confirm that your preferred doctors, hospitals, and prescriptions are still covered under your plan for 2025.
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Take Advantage of New Benefits – If your plan has added new perks or made changes to cost-sharing, make sure you understand how to use them.
Making the Right Decision for Your Medicare Advantage Plan in 2025
The changes coming to Medicare Advantage in 2025 could have a direct impact on your healthcare coverage and costs. With adjustments to drug costs, benefit notifications, plan offerings, and provider networks, it’s more important than ever to review your plan and ensure it still meets your needs.
If you have questions about your Medicare Advantage plan or need help navigating your options, speak with a licensed agent listed on this website for expert guidance tailored to your situation.
