“Medicare Advantage Shopping Season: Older Americans Face Thinner Benefits and Coverage Changes for 2025”
This fall, tens of millions of older Americans will go shopping for health insurance under the Medicare Advantage program-and in the process, many will find reduced benefits and coverage changes. Some will be in for an unpleasant surprise as some of their existing plans are no longer available going into 2025.
Medicare Advantage shopping season , over a million members are at risk of having their benefits stripped away. This follows a new revelation when the largest insurers are looking to cut costs and trim size. The companies are pulling out from certain markets that offer Medicare Advantage plans.
This is the private alternative to the federally managed healthcare program, available mainly to those 65 years of age and older. Now that companies are retreating into their shells, people affected by these actions will be unable to acquire plans as comprehensive or accessible as those they had before.
Industry observers predict that Medicare prescription drug plans would experience a bit of an increase in price as mandatory coverage enhancements become effective.
Of course, voters will be informed about these insurance changes just weeks before the election pick the next president and as Democrat Kamala Harris campaigns on promises to lower health care costs.
“Medicare Advantage Shopping Season: Challenges Loom Amid Election Distractions”
The Medicare Advantage shopping season overlaps with early voting, posing challenges for consumers.
“This could be devastating news for Vice President Harris,” said Massey Whorley, an analyst at Avalere. “Rising premiums highlight growing healthcare costs, which affect voter opinion of the current administration.”
Insurance agents note that the upcoming election complicates this year’s Medicare Advantage shopping season, starting next month. Many older Americans will juggle health insurance options while closely watching election returns, even as major insurers exit the market.
Next year, plans will cover over 35 million participants—about half of all enrollees. Analysts expect more individuals will need to renew coverage for 2025 due to insurers ending plans. This season will be particularly challenging as enrollees navigate unfamiliar options and make critical healthcare decisions.
“Medicare Advantage Shopping Season: Major Insurers Anticipate Customer Losses”
Medicare Advantage shopping season approaches, Humana is bracing itself for a blow, with the number of its customers it expects will be affected pegged at over half a million, or about 10% of its total enrollment, as a result of its decision to withdraw its Medicare Advantage plans from areas all over the country. While many may transfer into other Humana plans that would stay available, corporate executives still believe the company could lose a few hundred thousand members in the transition.
Medicare Advantage shopping season
Similarly, CVS Health’s Aetna has indicated it expects to lose customers, reflecting broader trends among major players in the market. Competitors have announced plans to shut down services in several states, raising serious concerns about the availability of Medicare Advantage options in the near term. This situation is likely to create a tough shopping season for many older Americans who rely on these plans for their healthcare needs.
With increasing competition and fewer choices, coupled with potential premium hikes, consumers may feel skittish as they navigate their options during this special enrollment period. Insurers are grappling with rising costs and cuts in government reimbursement, which further complicates the Medicare Advantage shopping season. As this reality unfolds, many consumers may find it challenging to secure the coverage they need.
Insurers are likely to abandon plans with lower quality ratings, particularly those serving a higher percentage of Black customers, according to Dr. Amal Trivedi from Brown University. This poses challenges for patients with multiple providers or cognitive impairments, like dementia, who may struggle to navigate options during the Medicare Advantage shopping season.
While most markets will still offer many plans this year, selecting a new one requires understanding out-of-pocket costs and coverage differences. “People don’t like change when it comes to health insurance because you don’t know what’s on the other side of the fence,” says Tricia Neuman, a Medicare expert at KFF.
Remaining plans may raise deductibles and reduce coverage, including popular flex cards used for utilities or groceries. Danielle Roberts, co-founder of Boomer Benefits, notes that these stored-value cards have gained popularity amid rising inflation. “It’s tough for someone on a fixed income to choose a health plan when $900 on a flex card in free groceries sounds appealing,” she said, highlighting the difficult trade-offs consumers face during this Medicare Advantage shopping season.
“Don’t ‘Sleep’ on Picking a Medicare Plan During the Medicare Advantage Shopping Season”
Some stand-alone Part D prescription drug plans will see cost increases, affecting over 13 million people who use them alongside traditional Medicare coverage.
The Centers for Medicare and Medicaid Services announced that, on average, premiums for these plans will decrease by about 4%, averaging around $40 next year. However, brokers and agents warn that prices can vary widely, with some plans still experiencing increases.
Additionally, options will be fewer, and the number of covered drugs will be reduced in many plans. Danielle Roberts indicated that some premiums could rise by at least $30 next year.
Fran Soistman, CEO of eHealth, noted that these changes could impact a customer base that typically switches plans when premiums increase. As the Medicare shopping season approaches, consumers must remain vigilant and informed.
All these changes form part of a congressional-approved reform of coverage, aimed at improving the benefits of Medicare recipients. Among other reforms, there is a new limit in out-of-pocket drug spending, set at $2,000 for individuals enrolled in Medicare. This is one of the largest efforts to eliminate costs for older adults for which Democrats and President Joe Biden have clamored so vigorously for 2022. This will help out more people afford their needed medications through capping out-of-pocket costs, thereby improving overall health results for Medicare recipients.
Medicare Advantage Shopping Season: Hoped Changes Will Bring More Benefits:
That benefit should translate to Medicare recipients in the long term, said Whorley, a health care analyst.
The Biden administration is utilizing billions from the Medicare trust fund to curb premium increases by supporting insurers and preventing potential hikes. However, Republican critics warn that this stopgap measure jeopardizes the trust fund’s long-term solvency, especially as insurers are limited to raising premiums no higher than $35 for the coming year.
Eligible individuals can enroll in 2025 plans during the Medicare Advantage shopping season from October 15 to December 7. Experts advise this is an ideal time to review new plans or coverage for renewal. “This is not a year to simply re-enroll in the status quo,” cautioned Whorley, urging people to actively engage during this crucial enrollment period.
