What You Need to Know About the Medicare Enrollment Period For 2025 Plans

The Medicare Annual Enrollment Period lasts from October 15-December 7. During this timeframe, you can make changes to your Medicare Advantage or Part D drug plan.

Those changes will take effect on January 1, 2025.

There are quite a few changes coming to the AEP this fall due to newly passed legislation, so it’s more important than ever to take a look at your current Medicare plan.

Here is what you need to know!

Scope of Appointment Waiting Period

In order to talk to you about Medicare Advantage or Part D prescription drug plans, CMS requires that you sign a Scope of Appointment form indicating that you want to hear about these types of plans.

For this enrollment season, we will still have to adhere to the 48-hour waiting period that was introduced in 2023. This means that unless you are an in‑person walk‑in meeting, we must have you sign this form and wait a full 48 hours before we can see you.

We apologize for this inconvenience, but our office is committed to adhering to CMS rules and regulations.

Recorded Calls and Disclaimers

Our office will continue to record calls and provide a disclaimer at the beginning of those phone calls per the rules released by the Centers for Medicare & Medicaid Services (CMS) in 2023.

The initial understanding was that all Medicare-related calls were required to be recorded, but the 2024 rule clarified that only enrollment calls need to be recorded and stored for 10 years.

We will continue to record all enrollment calls since our office is committed to complying with CMS rules and regulations.

New Pay Rules for Medicare Plan Agents

Starting in 2025, CMS will enforce new rules to ensure that agents and brokers help you find the Medicare plan that best fits your needs.

As always, when you use an agent to sign up for Medicare, you don’t need to pay us directly. We earn our income from a commission given by the insurance companies.

To prevent agents from steering enrollees toward one plan over another based on higher incentives, CMS is setting a clear, fixed payment amount for agents and brokers.

This change ensures that the recommendations you get are based on your health needs, not commissions.

At Sams/Hockaday, we always put your best interests first and are committed to providing you with unbiased advice during the Annual Enrollment Period which is why we prioritize an “education first” approach.

Protecting Your Personal Data from Third-Party Marketing Organizations

To keep your personal information safe, new 2025 rules ensure that any organization handling your Medicare data can't share it with others without your clear, written consent.

This means that if you provide your data through a call or link, it can only be shared with other organizations if you specifically agree to it with written consent.

Each organization that receives your data must get your separate, explicit permission before contacting you for marketing or enrollment.

Increasing Rates

Rates for healthcare services and insurance are naturally subject to increase over time, but we are currently experiencing a phenomenon known as the "COVID Catch-Up."

During the pandemic, many people postponed or avoided medical appointments, leading to undiagnosed conditions and worsening health issues.

As individuals now try to address these deferred healthcare needs, hospitals and doctors are facing higher costs for treatment.

This increased demand and complexity in care, combined with a period of unusually low claims during 2020-2021, have led to higher rates. As a result, insurance rates are adjusting to reflect the true costs of providing care in this changed landscape.

This means for 2025, you might see higher premiums for Medicare Supplement and Medicare Advantage plans, and some benefits may be reduced.

If you notice a price increase in your current plan, there's no need to worry. What you want to do is review your plan with your Sams/Hockaday agent during this AEP to ensure it is still the best fit for your healthcare needs.

Changes Due to the Inflation Reduction Act

The Inflation Reduction Act was passed in 2022 and it will lead to continued changes to Medicare all the way through 2029. Many of those changes will be coming in 2025.

Some notable changes to Part D and Medicare drug prices as a result of the Inflation Reduction Act are:

• $35 Insulin Cap: Insulin will be available at $35 per month for covered prescriptions
• Free Adult Vaccines: Recommended adult vaccines will be accessible without any cost-sharing.
• $2000 Annual Cap: Out-of-pocket prescription drug costs will be capped at $2000 per year starting in 2025.
• End of the Donut Hole: The "donut hole," a coverage gap that previously required beneficiaries to pay a higher percentage of their drug costs after they met a specific threshold for the initial coverage but hadn’t yet met the total out-of-pocket spending threshold, will be eliminated.
• Monthly Payment Option: Medicare Advantage and Part D plan enrollees can opt for capped monthly payments for out-of-pocket prescription drug costs rather than paying in full at the pharmacy.
• Expanded Low-Income Subsidy: The low-income subsidy program under Medicare Part D will extend to individuals earning up to 150% of the federal poverty level.
• Medicare Drug Price Negotiation: Medicare will directly negotiate with drug manufacturers to reduce the prices of some of the most expensive brand-name drugs covered under Medicare Part B and D.
• Inflation Rebates: A new law requires drug companies to pay Medicare a rebate if they increase drug prices faster than the rate of inflation.
• Access to Biosimilars: Changes to Medicare Part B will improve access to high-quality biosimilars, offering more affordable treatment options.

Mid-Year Notification of Unused Supplemental Benefits

To help Medicare Advantage enrollees make the most of their benefits, plans are now required to send a "Mid-Year Enrollee Notification" between June 30 and July 31 each year.

This notice will list any unused supplemental benefits from the first half of the year, including details on what the benefit covers, any costs, how to use it, and contact information for support.

The idea is to make sure you're actually benefiting from these perks, not just hearing about them in ads.

Annual Notice of Change

If you are enrolled in a Medicare Advantage or Medicare Part D plan, you should receive your Medicare Annual Notice of Change in September.

The Medicare Annual Notice of Change (ANOC) includes updates on any changes to your plan's coverage, costs, and provider network for the upcoming year.

Make sure to keep an eye out for your notice and call your Sams/Hockaday agent to review it. We’ll go over it with you to make sure your plan continues to meet your needs.

Creating a Medicare Account

If you haven't already signed up for a Medicare.gov account, please do so! It will make your life a lot easier when trying to select which drug plan is best for the upcoming year.

All medications you've filled throughout the year will show up on your account, allowing you to quickly choose which drug plan matches your prescription list.

Having a Medicare login is also very beneficial for us when it's time to serve you.

Phone Appointments Are Available

We are able to assist clients over the phone if desired! Oftentimes, a quick phone call is all we need to make sure you're in the right plan for 2025.

Communicate with your current agent to determine if a phone or in-office appointment is preferred.

Must-Know Details About AEP

Be prepared for a lot of commercials advertising free dental and vision benefits. You may even hear ads mentioning things like Part B givebacks, free flex cards, and more.

Private Medicare Advantage (MA) plans and big call centers advertise a lot during AEP, and while their extra perks are nice, availability differs, and we recommend choosing a plan for its health coverage, not the perks.

We can help you compare the available plans in Macon County.

Read More: 6 Simple Ways to Tell If Medicare Advantage Is Right For You

Your Medicare Supplement is not affected by the Medicare Enrollment Period. Your policy review is based on your policy anniversary date, and we keep an eye on your rates all year long.

What You Can Do During AEP

The Medicare Annual Enrollment Period isn’t a free-for-all for all types of insurance, but you can make a lot of changes – especially changes that’ll save you big money on your insurance and drug costs.

Medicare Advantage

Most of our clients have a Medicare Supplement. However, if you do have a Medicare Advantage plan, you can make some changes during the enrollment period, including:

• Switch from Original Medicare to a Medicare Advantage plan
• Switch from a Medicare Advantage plan back to Original Medicare
• Switch from a Medicare Advantage plan to a different Medicare Advantage plan
• Switch from a Medicare Advantage plan that doesn’t include prescription drug coverage to one that does, and vice versa

In short, you can make any change you want regarding your Medicare Advantage plan. You can drop it, switch it, keep it… whatever makes the most financial sense for you.

Not sure what to do with your Medicare Advantage plan? That’s what we’re here for. Using our contact form, let us know the name of the insurance company and we’ll help you out.

Contact an Agent Today

Medicare Part D (Prescription Drug Plan)

This is the only time of year you can make changes to your Medicare drug plan.

From October 15-December 7, you can:

• Enroll in a stand-alone Medicare Part D Prescription Drug Plan
• Switch from one stand-alone Medicare Part D Prescription Drug Plan to another one
• Drop your prescription drug coverage

You might be able to save some money by looking at the 2025 Part D plans. Drug plans change, and a lot has changed to Plan D for 2025, so please reach out to us for help! We'll make sure your drugs are still covered, we'll see how your premium is changing, and make sure the plan is still the most competitive one for you.

We can run a drug plan comparison based on the medications you take. We’ll help you choose the plan that's best for you for this year. This is a no-cost service!

Get Help With Your Drug Plan

Make the Most of Medicare's Enrollment Season

In order to make the most of the 2024 enrollment season for 2025 plans, your goal is to have great coverage for a great price. We come across a lot of individuals who believe getting the lowest premium is the goal, but it really isn't!

Your goal is to minimize your total out-of-pocket costs for the year. Premiums are only one part of the equation when it comes to all of your healthcare expenses.

You also have deductibles, coinsurance, and copays. Don’t make the mistake of choosing a plan for its low monthly premium only to find out later that your deductible is very high.

This can often happen with both Medicare Advantage plans and Part D drug plans, so be sure you understand all your costs before making any changes.

You also want to look at the full picture with Medicare Advantage plans.

What is the monthly premium, the deductible, the copays, and the coinsurance?

You also want to know what the network is like – Medicare Advantage plans often have limited networks, which means you’re only allowed to see certain doctors. That might end up being important to you!

Changing Plans Later On

What happens if you totally miss the Medicare annual enrollment season?

If you don’t take action from October 15-December 7, your options for changing Part D drug plans are very limited. You’d have to qualify for a special enrollment period, which includes situations like getting kicked off of your employer’s group plan or your plan getting terminated.

If you don’t qualify for a special enrollment period, you have to wait until October 15, 2025, to make changes.

For Medicare Advantage, the only change you can make after December 7, 2024, is to drop your plan and switch to Original Medicare. You can do that during the Medicare Advantage Open Enrollment Period (OEP), which is from January 1-March 31.

Conclusion

You don’t actually need to know every detail about the enrollment process – that’s what we’re here for.

Simply contact us, and our licensed agents will help you save money on your own health plan for next year.

Also, don’t forget to download your Enrollment Period To-Do List. This will help you save money before the 2024 Enrollment Period for 2025 plans is over and it’s too late!