Medicare and the Marketplace: What’s New for 2025

Starting in 2025, important changes are coming to Medicare and Health Insurance Marketplace plans. These changes aim to make it easier and more affordable to get the care and medicines you need. Here’s what you need to know. 

Medicare Changes 

1. Out-of-Pocket Cost Limit. If you have Medicare Part D, you won’t have to pay more than $2,000 per year out of pocket for prescription drugs covered by Part D (but may not apply to drugs from out-of-network pharmacies, depending on your plan). This can help you save money and avoid big bills at the pharmacy. 
2. Spread-Out Payments. You can sign up for the Medicare Prescription Payment Plan (MPPP, or "smoothing plan"), which allows you to spread out prescription drug payments throughout the year, rather than paying a large sum all at once. This can help you better manage your health care costs. However, if you are a Medicare Part D enrollee eligible for the Low-Income Subsidy (also known as Extra Help), the Extra Help program will likely provide greater financial benefits than the MPPP.
3. Free Vaccines. All vaccines covered under Medicare Part D will now be free, including those for seasonal flu, shingles, RSV and COVID-19.

 
Health Insurance Marketplace Changes 

1. Extended Subsidies. The premium subsidies for Health Insurance Marketplace plans, which were enhanced during the COVID-19 pandemic, will continue through 2025. These subsidies are based on income to help lower the cost of health insurance. 
2. Expanded Benefits. New benefits related to other health areas also are available. Basic dental care will now be covered, and steps are being taken to ensure that people covered under a plan have adequate access to health care providers.

 
Prepare for Open Enrollment

1. Review Your Plan Options: Look at the new Medicare Part D and Health Insurance Marketplace plans to see how these changes might benefit you. 
2. Check Your Medications: See if any of your medications are among those with negotiated prices. Also, estimate what you would have to pay out of pocket for your medications to see if it would help you to spread out the payments. 
3. Mark Your Calendar: Medicare Open Enrollment period starts Oct. 15, 2024. Health Insurance Marketplace open enrollment is Nov. 1 through Dec. 15 for coverage to start Jan. 1, 2025. 

 
These new changes for the 2025 health insurance plan year aim to make your health care more affordable and easier to manage. Read some examples of who may benefit. Be sure to review your options during the open enrollment period to take full advantage of these benefits. 

For more information, visit arthritis.org or contact our Helpline at 800-283-7800. We’re here to help you navigate these changes and find the best plan for your needs. 
 
Always check with your insurance provider for the most accurate and personalized information.