Research Options for Medicare Coverage During Annual Enrollment

By Ann Kinsella, Medica Vice President and General Manager of Medicare

The Medicare annual enrollment period kicked off last month and runs through December 7. Coverage for 2025 is set to bring some of the most significant changes to Medicare in a generation. These changes include a $2,000 limit on out-of-pocket Part D drug costs, and potential changes in Medicare Advantage plans, which nationally provides coverage to 55% of the total Medicare population. The percentage of seniors and other Medicare eligible individuals covered on a Medicare Advantage plan depends on the particular state and is more popular in certain parts of the country.?

Now, more than in previous years, it’s important for seniors and other Medicare eligible individuals to understand these changes and what to look for when evaluating their options. There’s good news for seniors in 2025, and a few changes to be mindful about.

The cost of coverage is largely stable

Medicare Advantage remains a very popular plan option in many parts of the country. And, according to the Centers for Medicare & Medicaid Services, more than 80% of Medicare Advantage enrollees will have the same or lower monthly premium next year if they remain in the same plan.

At Medica, all Medicare Advantage plans that had a $0 premium in 2024 will have a $0 premium in 2025. For plans with premiums, the average increase is 4.3% across our 5-state service area.

Medicare Cost plans, which are another popular option, also continue to offer stable pricing. Medica, which is the largest Cost plan provider in the United States, offers a Cost plan with $0 premium in Minnesota, Nebraska, North Dakota, South Dakota, and Wyoming.

Changes to drug coverage

You won’t spend more than $2,000 for drug copays and coinsurance under Part D, regardless of the plan you choose.

Some significant changes for Medicare Advantage plans

Medicare Advantage plans that include prescription drug may change or introduce new premiums, formularies, and copays. It’s a good idea to look at a plan’s formulary – the list of covered prescription medications – to see if they cover drugs you may be taking. Medica has focused on stability for its members and made very few changes to its formulary. Seniors and other Medicare eligible individuals will also want to see if their doctors and other providers are in their plan network in 2025. Many health systems will no longer accept some Medicare Advantage plans. There have been no significant changes to Medica’s network for 2025.

A few more things

If you're a Medicare Advantage enrollee, between June 30 and July 31, 2025, you’ll receive a personalized “Mid-Year Enrollee Notification of Unused Supplemental Benefits.” This letter will list any supplemental benefits such as vision or dental coverage that you haven’t used in the first six months of 2025.

There are some additional benefits for Medica Medicare Advantage members. These vary from one insurer to the next, so you should take a close look at them when choosing a plan. For example, Medica Medicare Advantage plans have these additional benefits: Up to $1,950 a year with allowances for dental, eyewear, over-the-counter health items, and hearing aids; free membership to fitness clubs; and coverage while traveling.

In 2025, access to mental health professionals may improve. More mental health providers can enroll as Medicare providers, including addiction counselors, licensed mental health counselors (LMHCs), and marriage and family therapists (LMFTs).

The bottom line is, that when it comes to your health care coverage, it pays to comparison shop to find the health plan features that meet your needs. You could save money while doing this and ensure coverage for your health care. If you need assistance, you can work with an insurance agent at no cost to you, or call health plans directly. The number for Medica is 1-888-356-3643, TTY 711, Monday – Sunday, 8 a.m. – 8 p.m. CT .

Y0088_1015059_M

Medica is a Cost, HMO-POS, and PPO plan with a Medicare contract.? Enrollment in Medica depends on contract renewal.