As the crisp air of fall settles in, seniors across northeastern Wisconsin are gearing up for one of the most important periods of the year: Medicare Open Enrollment. For 2025, this annual opportunity will be open October 15 to December 7, 2024, giving beneficiaries a chance to review and update their Medicare plans. Understanding the nuances of this period is essential for making informed decisions that can affect your healthcare for the coming year.

Why Open Enrollment Matters
Medicare Open Enrollment is a designated time when you can review your current Medicare coverage and make changes if needed. Whether you’re enrolled in Original Medicare (Part A and Part B), a Medicare Advantage Plan (Part C), or if you have a standalone Medicare Prescription Drug Plan (Part D), this is your chance to evaluate your options and select the plan that best suits your health needs and budget.

For many, this is a valuable opportunity to adjust their coverage based on changes in their health or financial situation. Perhaps your prescriptions have changed, or you’ve moved to a new area. Open Enrollment allows you to adapt your Medicare plan to reflect these new circumstances.

Key Changes to Watch for in 2025
Several important changes are anticipated for Medicare in 2025, and understanding these can help you make the most informed decisions during Open Enrollment.

  1. Medicare Prescription Payment Plan. Starting January 1, 2025, the Medicare Prescription Payment Plan allows Part D enrollees to pay out-of-pocket prescription costs in monthly installments rather than upfront. Participants pay $0 at the pharmacy and are billed monthly by their Part D plan sponsor, who pays pharmacies in full promptly.
  2. Lower Out-of-Pocket Maximum for Prescriptions. Starting in 2025, Medicare Part D enrollees who reach “catastrophic coverage” will see significant savings. The new out-of-pocket maximum for 2025 is $2,000 as compared to $8,800 in 2024.

Steps to Take During Open Enrollment

  1. Review Your Current Plan. Start by assessing your current Medicare plan. Consider whether your health needs have changed and if your current plan still meets those needs. Pay attention to any changes in coverage, premiums, and out-of-pocket costs.
  2. Compare New Options. Use the Medicare Plan Finder tool on the official Medicare website to compare available plans. This tool allows you to input your current prescriptions and preferred doctors to see how different plans stack up in terms of coverage 
and cost.
  3. Consider Your Health Needs. Reflect on any upcoming health changes or treatments. For example, if you have a new health condition or are planning a surgery, make sure your chosen plan provides adequate coverage for these needs.
  4. Seek Assistance. If the process feels overwhelming, consider reaching out to your local ADRC or a State Health Insurance Assistance Program (SHIP) advisor for personalized guidance. These resources can help you navigate the complexities of Medicare and make well-informed choices.
  5. Enroll or Make Changes. Once you’ve selected the best plan for you, follow the enrollment instructions carefully. If you’re making changes, ensure they’re completed by the December 7 deadline to avoid any lapse in coverage.

Avoiding Common Pitfalls
To make the most of Open Enrollment, be aware of these common pitfalls.

  1. Missing the Deadline. Changes cannot be processed outside the Open Enrollment period, so adhere to the deadline.
  2. Not Reviewing Your Plan. Plans change from year to year, so it’s important to review your plan even if you’re happy with it. Covered medications, providers, and facilities can change each year, which means an annual review is the only way to ensure you’re getting the best value for your unique needs.

Navigating Medicare Open Enrollment can seem daunting, but with careful planning and research, you can select the best options for your health and financial needs. Take the time to review your choices, compare plans, and consult with your local ADRC for free unbiased expert advice to ensure you’re well prepared for the year ahead.

Submitted by Aging & Disability Resource Center (ADRC) of Brown County. adrcofbrowncounty.org

Photographs provided by Aging & Disability Resource Center (ADRC) of Brown County.

ADRC OF BROWN COUNTY
(920) 448-4300
adrcofbrowncounty.org