Another year brings significant updates to Medicare, and 2025 is no exception.
From rising costs and expanded benefits to changes in Medicare Advantage and Prescription Drug Plans, understanding these updates is key to guiding your clients through their options.
2025 Medicare Costs
As always, Medicare costs are changing in 2025.
Related: 2025 Medicare Parts A & B Premiums and Deductibles
Part B Premium & Deductible Increases
In 2025, the standard Medicare Part B premium is $185, an increase of $10.30 from $174.70 in 2024.
The Part B deductible is also going up to $257 in 2025, a $17 increase from 2024.
Note: to easily show these costs to your clients, you can download our customizable 2025 Medicare Costs handout:
Part B IRMAA
For about 8% of people with Medicare Part B that have a high income, their Part B premiums will range from $259-$628.90 per month.
Part A Costs
Here are some quick Part A cost highlights for 2025:
- 2025 Part A premium: up to $518 per month
- 2025 Part A deductible: $1,676 (increase of $44 from 2024)
- 2025 Part A coinsurance for Days 1-60: $0
- 2025 Part A coinsurance for Days 61-90: $419 per day
- 2025 Part A coinsurance for lifetime reserve days: $838 per day
- Skilled nursing facility daily coinsurance for days 21-100: $209.50
Most people don't pay a monthly premium for Part A. For those that paid Medicare taxes for less than 30 quarters, the standard Part A premium is $518 in 2025 (a $13 increase from 2024). And for those that paid Medicare taxes for 30-39 quarters, the standard Part A premium is $285 in 2025 (a $7 increase from 2024).
Help your clients understand their 2025 Medicare costs with customizable and fillable Client Guide to Medicare Parts A & B.
Medicare Technology
Integrity has made serious investments in technology to help you produce more and serve your clients more efficiently.
We're so excited about the recent developments with MedicareCENTER and LeadCENTER, and we're excited to continue sharing new features and updates in 2025.
MedicareCENTER has had a ton of recent improvements.
- Contact Map: Contact Map, now available in the Integrity for Agents mobile app, allows you to find, filter and sort your clients by location. Search results show up on a zoomable map so you can connect with clients more efficiently.
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Low Income Subsidy (LIS): Now, you have the option to indicate if your client is eligible for LIS assistance right in your Contact Profile. Plan options are then automatically filtered accordingly to reflect the LIS status.
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Multi-pharmacy: You can now enter up to three pharmacies at once and compare prices for your clients!
2025 PDP Changes
Here’s what you need to know about the key changes to stand-alone Prescription Drug Plans (PDPs) in 2025 and how they might impact your clients.
Fewer Part D Plans
The number of stand-alone Prescription Drug Plans (PDPs) is dropping by 26% in 2025, leaving 524 options nationwide, with at least 12 plans per state.
LIS recipients face an even sharper reduction, with just 115 premium-free "benchmark" plans available, varying from two to six options by state. Meanwhile, Medicare Advantage plans with drug coverage (MA-PDs) are expanding, offering more bundled options at lower costs.
Premium Increases
The base Part D premium rises 6% in 2025 to $36.78.
While increases are capped under the Inflation Reduction Act, clients may see varying costs based on their plans, making it even more important that you help them compare options.
Expanded LIS Benefits
Full Low-Income Subsidy (LIS) benefits, extended in 2024 to all qualifying beneficiaries, remain in place for 2025, significantly lowering drug costs for eligible clients.
Access to Negotiated Drugs
New Medicare drug price negotiations could lower costs, but many independent pharmacies may not stock these medications due to high upfront costs.
Clients relying on drugs like Eliquis, Jardiance, or Januvia may face limited availability, particularly in smaller pharmacies. Keep an eye on this as changes unfold.
2025 Medicare Advantage Changes
Medicare Advantage continues to grow, with enrollment expected to exceed 36 million by 2025, representing 60% of the Medicare population.
While total plans are slightly down by 3%, with 5,218 options nationwide, the increase in enrollment highlights shifting beneficiary preferences.
Related: Medicare Advantage Highlights For the 2025CY AEP
Premium Trends
The average Medicare Advantage premium will drop to $17.00 in 2025, with 87% of plans having premiums under $50 and 58% offering $0 premiums.
However, $0 premium/$0 drug deductible plans will decline from 39% in 2024 to 22% in 2025.
New Mid-Year Statement
Starting in 2025, Medicare Advantage plans will send a personalized Mid-Year Enrollee Notification of Unused Supplemental Benefits to beneficiaries between June 30 and July 31.
This new requirement aims to help enrollees understand and utilize their unused supplemental benefits, such as dental, vision, and fitness perks. Each statement will include a detailed list of unused benefits, instructions on how to access them, and relevant support information.
We see this as a great opportunity to connect with clients midyear. By reviewing these statements with beneficiaries, you can ensure they’re maximizing their plan benefits while strengthening your relationship as a trusted advisor.
Learn more: How to Maximize the New Medicare Advantage Midyear Statement (2025)
Compliance and Market Changes
The 2024 AEP for 2025 contracts brought new challenges:
- Plan Switching: An estimated 40-70% of beneficiaries may change plans due to CMS policy shifts.
- Part B Give Backs: Plans offering rebates for Part B premiums will increase by 93%.
- Stricter Consent Requirements: Compliance rules now demand clearer consent and transparency in lead generation.
With these shifts, agents play a pivotal role in helping clients navigate their options effectively.
Medicare Benefit Changes
For 2025, there are a few benefit changes:
- Expanded Mental Health Coverage: In 2025, Medicare offers more comprehensive mental health services, including coverage for intensive outpatient programs, as well as services provided by marriage and family therapists and mental health counselors. During annual “Wellness” visits, providers can now assess social needs through health risk assessments and refer beneficiaries for appropriate support.
- Enhanced Caregiver Support: Medicare is increasing resources for caregivers, including training to help them provide better care and relief support for caregivers of hospice patients. A new pilot program will also offer additional support for individuals living with dementia and their caregivers.
- Postal Service Health Benefits Program: Starting January 1, 2025, U.S. Postal Service employees, retirees, and their families will transition to a new Postal Service Health Benefits Program, replacing coverage under the Federal Employee Health Benefits program.
- Telehealth Coverage Adjustments: Through December 31, 2024, telehealth services remain accessible from any location, including beneficiaries’ homes. Starting in 2025, most telehealth services will require beneficiaries to be in a medical facility located in a rural area, though mental and behavioral health services will continue to be accessible from home, regardless of location.
Conclusion
Medicare continues to evolve, and it's important that we stay on top of those updates so we can educate our clients.
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