The Medicare Landscape in 2025: A Comprehensive Analysis of Cost, Coverage, and Choice

Section 1: A Landmark Year: The Inflation Reduction Act Reshapes Prescription Drug Coverage

The year 2025 marks a watershed moment for the Medicare program, driven by the full implementation of transformative provisions within the Inflation Reduction Act (IRA).

This legislation fundamentally re-engineers the Medicare Part D prescription drug benefit, introducing unprecedented financial protections for beneficiaries while simultaneously creating new economic pressures that are reshaping the strategies of private insurers.

The changes, centered on capping out-of-pocket costs and simplifying the benefit design, represent the most significant structural reform to Part D since its inception.

Understanding the mechanics of these provisions is essential to grasping the cascading effects on plan premiums, benefit offerings, and the choices millions of Americans will face.

1.1. The $2,000 Out-of-Pocket Cap: A New Paradigm of Financial Protection

The cornerstone of the IRA’s reforms is the establishment of a hard annual cap on out-of-pocket (OOP) spending for prescription drugs, which took effect on January 1, 2025.

For the first time in the program’s history, beneficiaries enrolled in any Medicare Part D plan—whether a stand-alone Prescription Drug Plan (PDP) or a Medicare Advantage Prescription Drug (MA-PD) plan—will have their yearly drug costs limited to $2,000.¹

This cap is a monumental shift from the previous structure, where beneficiaries could face thousands of dollars in additional costs in the catastrophic coverage phase.¹

The mechanics of this cap are straightforward.

The $2,000 limit encompasses all costs that count toward a beneficiary’s True Out-of-Pocket (TrOOP) spending, which includes the annual plan deductible, as well as any copayments and coinsurance paid for covered medications.²

It is critical to note that monthly plan premiums are not included in this calculation.²

Once a beneficiary’s personal spending reaches the $2,000 threshold, their cost-sharing obligation drops to $0 for all covered Part D drugs for the remainder of the calendar year.¹

The projected impact on beneficiaries is substantial.

An estimated 3.2 million individuals are expected to see direct savings, with an average reduction in spending of $1,500 in 2025.¹⁰

For those with serious or chronic conditions requiring high-cost specialty drugs, such as medications for cancer or autoimmune diseases, the relief will be even more profound, with potential savings exceeding $3,000.¹⁰

These individuals may reach the $2,000 cap within the first few months of the year, providing immediate and sustained financial protection from previously uncapped expenses.¹⁰

This protection applies universally to all Part D enrollees, regardless of their income level.³

To ensure the cap keeps pace with rising drug costs over time, the law provides for it to be indexed annually to the rate of Part D drug inflation.

Projections indicate the cap will rise to approximately $2,100 in 2026.³

1.2. The End of the “Donut Hole”: Simplifying the Part D Benefit Structure

In concert with the OOP cap, the IRA dismantles the notoriously complex and confusing four-phase structure of the Part D benefit.

The former model—consisting of the Deductible, Initial Coverage, Coverage Gap (colloquially known as the “donut hole”), and Catastrophic phases—has been a source of anxiety and unpredictability for beneficiaries for years.¹

In its place, a simplified three-phase model is implemented for 2025, providing a more linear and understandable cost-sharing progression for beneficiaries.⁸

The new structure is as follows:

1. Annual Deductible Phase: The beneficiary is responsible for 100% of their prescription drug costs until they meet their plan’s annual deductible. The standard deductible amount set by CMS for 2025 is $590, although individual plans may offer a lower deductible.⁸
2. Initial Coverage Phase: After the deductible is met, the beneficiary enters the initial coverage phase, where they are responsible for a 25% coinsurance or an equivalent copayment for their covered drugs. During this phase, the financial liability is shared among multiple parties. For applicable brand-name drugs, the plan sponsor covers 65% of the cost, and the drug manufacturer provides a 10% discount. For all other covered drugs (e.g., generics), the plan sponsor covers 75%.⁸ This phase continues until the beneficiary’s cumulative out-of-pocket spending reaches the new $2,000 cap.
3. Catastrophic Coverage Phase: Once a beneficiary’s OOP costs hit the $2,000 limit, they immediately move into the catastrophic phase. In this final stage, their personal liability for covered drugs drops to $0 for the rest of the year.¹ The cost responsibility is reallocated: the plan sponsor now covers 60% of the cost of applicable drugs, the manufacturer provides a larger 20% discount, and Medicare’s reinsurance subsidy covers the remaining 20%.⁶

This redesigned benefit stands in stark contrast to the 2024 structure, where beneficiaries who reached the catastrophic threshold (after approximately $8,000 in OOP costs) were still responsible for a 5% coinsurance on all subsequent drugs.¹

The elimination of the “donut hole” removes the dreaded period where beneficiaries often experienced a sudden and significant increase in their cost-sharing, thereby creating a more predictable and financially secure benefit from start to finish.¹⁰

Table 2: The New Part D Standard Benefit Design (2025)

Benefit Phase	Beneficiary Pays	Plan Pays	Manufacturer Pays	Government (Medicare) Pays	Phase Ends When…
1. Annual Deductible	100%	0%	0%	0%	Beneficiary has paid the plan’s deductible (up to $590).
2. Initial Coverage	25%	65% (on applicable drugs) / 75% (on other drugs)	10% (Discount on applicable drugs)	0%	Beneficiary’s total OOP costs reach $2,000.
3. Catastrophic Coverage	$0	60% (on applicable drugs)	20% (Discount on applicable drugs)	20% (Reinsurance on applicable drugs)	End of the calendar year.
Source Snippets:	1	6	6	6	1

1.3. The Medicare Prescription Payment Plan: A Tool for Budgeting, Not Savings

To further mitigate the financial burden of prescription drug costs, another key IRA provision launches on January 1, 2025: the voluntary Medicare Prescription Payment Plan.¹

This program is designed to help beneficiaries manage cash flow by allowing them to pay their out-of-pocket drug costs in predictable monthly installments over the course of the year, rather than facing large, lump-sum payments at the pharmacy counter.

Under this program, a participating beneficiary will pay $0 at the pharmacy when they fill a prescription for a covered Part D drug.¹¹

Instead, their Part D plan sponsor will track their accumulated OOP costs and bill them in monthly installments.

The amount of the monthly bill is calculated by taking the beneficiary’s total OOP costs incurred to date and dividing that amount by the number of months remaining in the calendar year.¹¹

Participation is free, and plans are prohibited from charging interest or late fees.²

It is essential to clarify that this program is a budgeting tool and does not, in any way, lower a beneficiary’s total annual drug costs.²

Its primary value is in smoothing payments to avoid “sticker shock,” particularly for individuals who anticipate high drug costs early in the year and are likely to reach the $2,000 OOP cap quickly.⁸

Beneficiaries must actively opt into the program by contacting their plan sponsor; enrollment is not automatic.¹⁶

To facilitate access, plans are required to process enrollment requests made during 2025 within 24 hours, and pharmacies must notify beneficiaries at the point of sale if they may be eligible for the program.¹⁷

1.4. Foundational Cost Controls: Insulin Caps, Free Vaccines, and Inflation Rebates

The landmark changes for 2025 build upon a foundation of crucial cost-control measures from the IRA that were implemented in prior years and remain in full effect.

These provisions continue to provide significant, targeted financial relief for millions of beneficiaries.

First, the monthly copay cap of $35 for a one-month supply of each covered insulin product remains in place for all Part D plans.³

This cap also applies to insulin administered through a medical pump covered under Medicare Part B, ensuring broad protection for people with diabetes.

Second, beneficiaries continue to have access to adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP), such as the vaccine for shingles (herpes zoster), at $0 cost-sharing.³

Part D plans are prohibited from applying a deductible or any other cost-sharing to these preventative services.

Third, the Medicare Prescription Drug Inflation Rebate Program continues to discourage excessive price hikes.

This program requires drug manufacturers to pay a rebate to Medicare if they increase the prices of certain drugs faster than the rate of inflation.⁵

This directly benefits consumers through lower cost-sharing.

For the first quarter of 2025, CMS has identified 64 drugs covered under Part B that will have a reduced coinsurance for beneficiaries because their prices rose too quickly.

The savings for individuals can be substantial, ranging from as little as $1 to as much as $10,818 per day for a patient taking certain high-cost medications.⁵

CMS plans to invoice manufacturers for these Part B and Part D rebates in the latter half of 2025, with the collected funds being deposited into the Medicare trust fund to help ensure the program’s long-term sustainability.⁵

1.5. The Long View: Medicare’s Drug Price Negotiation Program Matures

While the direct financial impact of Medicare’s new drug price negotiation authority will not be felt by consumers until 2026, the program continues to mature and expand in 2025, signaling a permanent structural shift in how the federal government pays for high-cost pharmaceuticals.

The negotiation program, a long-debated policy finally established by the IRA, empowers Medicare to directly negotiate prices with manufacturers for a select list of expensive drugs that lack generic or biosimilar competition.²¹

The first round of negotiations, covering 10 Part D drugs, concluded in 2024, with the newly negotiated “maximum fair prices” set to take effect in 2026.

Building on this, in January 2025, CMS announced the list of 15 additional Part D drugs selected for the second round of negotiations.²¹

These prices will become effective in 2027.

The inclusion of widely used and high-expenditure drugs in these negotiation rounds, such as the diabetes and obesity medications Ozempic and Wegovy in the second cohort, underscores the program’s potential to generate significant savings for both beneficiaries and the Medicare program in the coming years.²¹

The program’s framework is also being refined, with modifications to provisions like the orphan drug exclusion that will influence which drugs become eligible for negotiation in the future.²²

The continued implementation of this program represents a long-term strategy to control drug spending at its source, complementing the immediate out-of-pocket protections for beneficiaries.

While the IRA successfully provides a ceiling on catastrophic drug costs for beneficiaries, its structural reforms have initiated a significant reallocation of financial pressure across the Medicare ecosystem.

This has resulted in a dynamic where costs, suppressed in one area for the consumer, are re-emerging in other forms, such as higher premiums or reduced benefits.

This phenomenon can be understood by tracing the new flow of financial liability.

The first step in this process is the direct benefit to consumers: the IRA caps their out-of-pocket spending at $2,000 and, crucially, eliminates the 5% coinsurance they previously paid in the catastrophic phase.¹

The second, and perhaps most impactful, step is the simultaneous restructuring of the government’s role.

Under the old system, Medicare’s reinsurance program covered 80% of a beneficiary’s costs in the catastrophic phase.

The IRA slashes this government subsidy to just 20% for brand-name drugs and 40% for generics.⁶

This creates the third step: a massive and uncapped financial risk for the private insurance plans that administer Part d+. Where a plan was previously responsible for only 15% of costs for a high-spending beneficiary in the catastrophic phase, it is now liable for 60% of those costs.¹³

For a plan covering patients with conditions like cancer, multiple sclerosis, or rare diseases who rely on specialty drugs that can cost tens or hundreds of thousands of dollars per year, this liability shift is dramatic.¹¹

This leads to the final step: insurers must adjust their financial models to mitigate this new, substantial risk.

Their levers to do so are limited and have direct consequences for all enrollees.

In the stand-alone PDP market, the most direct response is to raise premiums, which is reflected in the projected premium increases for 2025.¹²

In the highly competitive Medicare Advantage market, where zero-dollar premiums are a critical marketing tool, plans are instead shifting costs in less direct ways.

They are increasing cost-sharing for medical services before the cap is reached and, most notably, reducing the value and availability of popular supplemental benefits like dental, vision, and over-the-counter allowances to free up rebate dollars to cover their new drug liabilities.²³

Therefore, while the IRA is a landmark achievement in making drugs more affordable, it has forced a complex series of trade-offs.

Beneficiaries are now protected from financial ruin due to drug costs, but this protection is being financed, in part, by higher costs and reduced benefits in other parts of their coverage.

This reality makes the 2025 plan selection process a holistic assessment of total potential healthcare spending, not just a comparison of drug benefits.

Section 2: The Evolving Cost Equation for Beneficiaries

As the landscape of Medicare benefits undergoes a historic transformation, the cost equation for the program’s 65 million beneficiaries is also evolving.

The year 2025 presents a duality: while the IRA provides unprecedented relief from catastrophic drug expenses, the standard costs associated with medical coverage continue their steady upward climb.

This divergence creates a complex financial environment where beneficiaries must weigh rising fixed costs against new forms of protection and variable costs within private plans.

Analyzing these shifts is crucial for understanding the total financial liability an individual may face in the coming year.

2.1. Original Medicare: Analyzing the 2025 Increases in Part A & B Costs

For the millions of Americans enrolled in Original Medicare, 2025 brings noticeable increases in standard premiums and deductibles.

These adjustments, determined annually according to provisions in the Social Security Act, reflect projected growth in national health expenditures.²⁶

The most widely felt change is in the Medicare Part B premium.

The standard monthly premium, which covers physician services, outpatient care, and durable medical equipment, will increase by $10.30, rising from $174.70 in 2024 to $185.00 in 2025.⁹

This premium is typically deducted directly from Social Security benefits.

Alongside the premium increase, the annual Part B deductible will also rise.

Beneficiaries must pay this amount out-of-pocket for their medical care before Part B coverage begins.

For 2025, the deductible is set at

$257, an increase of $17 from the $240 deductible in 2024.²⁶

Costs for inpatient hospital care under Medicare Part A are also increasing.

If a beneficiary is admitted to a hospital, they are responsible for the Part A deductible for each benefit period.

In 2025, this deductible will be $1,676, a $44 increase from $1,632 in 2024.²⁶

For longer hospital stays, daily coinsurance amounts have also been adjusted upwards.

For days 61 through 90 of a hospitalization, the daily coinsurance will be $419, and for care in a skilled nursing facility, the daily coinsurance for days 21 through 100 will be $209.50.²⁶

While the vast majority of beneficiaries receive premium-free Part A based on their work history, the small percentage who must purchase this coverage will also see a cost increase.

The full monthly premium for Part A will be $518 in 2025, a $13 increase from the previous year.²⁶

The Centers for Medicare & Medicaid Services (CMS) attributes these across-the-board increases primarily to projected price changes and assumed growth in the utilization of healthcare services, which are consistent with historical experience.²⁶

Table 1: 2024 vs. 2025 Medicare Core Costs at a Glance

Cost Component	2024 Value	2025 Value	Change	Source Snippet(s)
Part B Standard Monthly Premium	$174.70	$185.00	+$10.30	26
Part B Annual Deductible	$240	$257	+$17	26
Part A Inpatient Hospital Deductible	$1,632	$1,676	+$44	26
Average MA-PD Monthly Premium	~$14	~$13	-$1	29
Average Stand-Alone PDP Monthly Premium	~$42	~$45	+$3	12
MA Plan Median MOOP (In-Network)	$5,000	$5,400	+$400	25
Part D OOP Cap	$8,000 (Catastrophic Threshold)	$2,000 (Hard Cap)	-$6,000	1

2.2. The Private Plan Premium Paradox: Stability in Medicare Advantage, Pressure on Part D Stand-Alone Plans

In stark contrast to the rising costs in Original Medicare, the premium landscape for private plans presents a paradox.

Medicare Advantage plans continue to offer remarkable premium stability, while stand-alone Part D plans are facing significant upward pressure.

For Medicare Advantage plans that include prescription drug coverage (MA-PDs), the average enrollment-weighted monthly premium has remained low and has even declined over the past decade.²⁹

In 2025, this average premium is just

$13 per month.²⁹

This figure is driven by the fact that a vast majority of MA enrollees—76% in 2025—are in plans that charge no additional monthly premium beyond the standard Part B premium they must continue to pay.²⁹

The situation for stand-alone PDPs, which provide drug coverage for those in Original Medicare, is markedly different.

These plans are experiencing direct premium pressure as a result of the Part D redesign.

The estimated average enrollment-weighted monthly premium for a PDP is projected to be $45 in 2025, a modest increase from $42 in 2024, but nearly six times higher than the average premium for the drug portion of an MA-PD plan.¹²

To manage the transition, some PDPs are participating in a new premium stabilization demonstration program, which allows them to increase their premiums by a maximum of $35 for 2025.¹²

This divergence in premium trends is not arbitrary; it is a direct result of the fundamental economic differences between the two plan types.

MA plans receive capitated payments from the government to cover all Part A, B, and D services.

In 2025, these payments are, on average, $2,255 per enrollee higher than the plans’ estimated costs for providing standard Medicare benefits.²⁹

These excess funds, known as “rebate” dollars, can be used to enhance benefits, lower cost-sharing, and, most importantly, buy down premiums for both medical and drug coverage.

This powerful cross-subsidization mechanism is entirely unavailable to stand-alone PDPs, which must fund their operations solely from beneficiary premiums and direct government subsidies for drug costs.¹²

2.3. Beyond Premiums: The Rise of Maximum Out-of-Pocket Limits in Medicare Advantage

While MA plan premiums remain attractively low, a closer look reveals that costs are shifting to other areas of the benefit design.

A key indicator of this trend is the increase in the maximum out-of-pocket (MOOP) limit for Part A and Part B services.

The MOOP is a crucial protection for MA enrollees, as it caps their annual spending on medical care, a protection that does not exist in Original Medicare without a supplemental policy.

For 2025, the median MOOP for individual MA plans is set to increase by 8%, rising from $5,000 in 2024 to $5,400.²⁴

This means that half of all plans will have a MOOP higher than this amount.

The statutory ceiling for the MOOP, set by CMS, has also risen to $9,350 for in-network services in 2025.²⁵

Although the vast majority of plans (93.7%) set their limits well below this regulatory maximum, the clear upward trend in the median limit indicates that beneficiaries face a greater potential financial exposure for medical services than in previous years.²⁵

This increase in the MOOP is a direct illustration of the cost-shifting dynamic at play.

To absorb the significant new financial liabilities imposed by the Part D redesign, MA plans are increasing the potential medical cost-sharing for their enrollees.

This allows them to keep their monthly premiums low and remain competitive in a market where the “$0 premium” is a primary selling point, but it comes at the cost of higher potential spending for beneficiaries who require significant medical care.

The 2025 cost landscape reveals a fundamental strategic divergence between MA plans and stand-alone PDPs, driven by their distinct business models.

This is creating what could be described as a “tale of two Medicares,” where the very definition of “cost” is becoming increasingly fragmented and nuanced.

For beneficiaries, this means that the lowest monthly premium is no longer a reliable indicator of the most cost-effective plan.

The data clearly shows this split: MA premiums are low and stable, while PDP premiums are comparatively high and rising.¹²

The reason is structural.

MA plans operate as integrated insurers, receiving a single capitated payment to manage the total cost of care across Parts A, B, and d+. This allows them to use rebate dollars generated from efficiencies in medical care delivery to subsidize their drug premiums.²⁹

PDPs, in contrast, are single-product insurers.

They lack this ability to cross-subsidize.

When faced with the immense financial pressure of the IRA’s Part D redesign, their only direct lever to offset the new risk is to raise premiums and deductibles.¹²

MA plans, on the other hand, face intense market pressure to maintain their low- or zero-dollar premiums, which are a cornerstone of their marketing and enrollment strategy.³⁰

Instead of raising premiums, they are absorbing the new drug costs by subtly increasing the MOOP for medical services and trimming the value of their supplemental benefits.²⁵

This creates a complex decision matrix for beneficiaries.

A relatively healthy individual might be drawn to a $0 premium MA plan, accepting the higher MOOP as a remote risk.

However, an individual with multiple chronic conditions who anticipates needing significant medical care might find that the higher, more transparent premium of a PDP combined with Original Medicare and a Medigap plan provides more predictable total costs, even with the higher upfront monthly outlay.

The concept of “value” in Medicare is therefore shifting from a simple premium comparison to a sophisticated, individualized risk assessment of total potential financial exposure across medical, drug, and supplemental benefit categories.

Section 3: The Medicare Advantage Crossroads: Unprecedented Growth Meets Strategic Retrenchment

The Medicare Advantage (MA) market in 2025 stands at a fascinating and complex crossroads.

On one hand, the program continues its relentless growth trajectory, solidifying its position as the dominant form of Medicare coverage for a majority of Americans.

On the other hand, a confluence of new financial and regulatory pressures is forcing a strategic retrenchment among insurers, leading to fewer plan choices and a notable reduction in the generosity of supplemental benefits for the first time in recent history.

This duality of expansion and contraction defines the MA landscape in 2025.

3.1. Market Dynamics: Enrollment Milestones, Plan Consolidation, and Insurer Strategy

The growth of Medicare Advantage shows no signs of slowing.

In 2025, the program has crossed a significant threshold, with more than half (54%) of all eligible Medicare beneficiaries now enrolled in an MA plan.³²

This represents a total enrollment increase of 1.3 million individuals, or 4%, between 2024 and 2025 alone.³²

Projections from the Congressional Budget Office forecast that this trend will continue, with the share of beneficiaries in MA plans expected to reach 64% by 2034.³²

This growth, however, belies a more turbulent reality at the plan level.

The market remains highly concentrated, with two parent organizations, UnitedHealth Group and Humana, accounting for nearly half (46%) of all MA enrollees nationwide.³²

More strikingly, despite the increase in total enrollment, the number of MA plans available to beneficiaries is contracting.

For 2025, the total number of MA plans offered nationally will decrease by 2.8%.

This net decrease is driven by a substantial

6.5% reduction in the number of individual MA plans available for general enrollment.

This contraction in the mainstream market is partially offset by an 8.5% increase in the number of Special Needs Plans (SNPs), indicating a strategic shift by insurers.²⁴

The practical consequence of this plan consolidation is significant: an estimated 1.98 million current MA beneficiaries are enrolled in plans that are being terminated for 2025, forcing them to navigate the market and select a new coverage option.²⁴

3.2. The Great “Right-Sizing” of Supplemental Benefits

For years, a key selling point of MA plans has been the inclusion of “extra” benefits not covered by Original Medicare, such as dental, vision, and hearing care.

The trend has been one of continuous expansion and enrichment of these benefits.

However, 2025 marks a clear reversal of this trend.

For the first time in recent memory, the aggregate value of supplemental benefits offered by MA plans is decreasing.²³

While the core benefits of dental, vision, and hearing remain widely available, offered by over 97% of plans, their scope and generosity are being curtailed.²⁴

For example, comprehensive dental coverage, which had been one of the fastest-growing supplemental benefits, saw a 2% reduction in the number of plans offering it in 2025.³⁴

Analysis indicates that reductions in the value of dental benefits are a primary driver of the overall decline in supplemental benefit value.²³

The reductions are even more pronounced for other popular benefits that address social determinants of health.

The share of plans offering an over-the-counter (OTC) allowance, which provides funds for members to purchase health-related items, dropped sharply from 85% in 2024 to 73% in 2025.³³

Similarly, the prevalence of meal benefits (e.g., meals provided after a hospital stay) fell from 72% to 65% of plans, and transportation benefits for medical appointments fell from 36% to 30%.³³

In a contrasting and strategically significant move, there has been a sharp increase in the availability of the Part B premium rebate, often marketed as a “giveback” benefit.

The share of enrollees in plans offering a reduction in their monthly Part B premium has surged from 12% in 2024 to 32% in 2025.²⁹

This provides a tangible, easily advertised dollar amount to attract beneficiaries.

However, the value of this rebate is often modest.

Among the plans offering it, nearly a third (30%) provide a rebate of $10 or less per month.³³

Table 3: Medicare Advantage Supplemental Benefit Trends (2024-2025)

Supplemental Benefit	% of Individual MA Plans Offering (2024)	% of Individual MA Plans Offering (2025)	Change	Source Snippet(s)
Dental (Comprehensive)	~99% (prevalence high)	~97% (2% reduction)	-2%	33
Vision (Exams/Hardware)	~99% (prevalence high)	~97% (slight decrease)	-2%	33
Hearing (Exams/Aids)	~98% (prevalence high)	~97% (slight decrease)	-1%	33
Over-the-Counter (OTC) Allowance	85%	73%	-12%	33
Meal Benefit (e.g., post-hospitalization)	72%	65%	-7%	33
Transportation (Medical)	36%	30%	-6%	33
Part B Premium Rebate	19% of plans (12% of enrollees)	32% of plans (32% of enrollees)	+13%	29

3.3. The Ascendancy of Special Needs Plans (SNPs)

The contraction in individual plan offerings is juxtaposed with a significant expansion in the SNP market.

SNPs are a type of MA plan designed for specific, high-need populations.

In 2025, SNP enrollment accounts for 21% of all MA beneficiaries, a substantial increase from 14% in 2020.³²

As noted, the number of SNP plans being offered is growing by 8.5% this year.²⁵

This growth is not uniform across all SNP types:

• Dual-Eligible SNPs (D-SNPs): These plans, designed for individuals eligible for both Medicare and Medicaid, remain the largest category of SNP by enrollment. New rules for 2025 are aimed at improving the integration of Medicare and Medicaid benefits and enhancing care coordination for this vulnerable population.³⁰
• Chronic Condition SNPs (C-SNPs): This is the most dynamic and fastest-growing segment of the SNP market. Enrollment in C-SNPs surged by an astonishing 71% between 2024 and 2025.³² This growth is highly targeted, with 97% of all C-SNP enrollees in plans specifically designed for individuals with diabetes or cardiovascular conditions.³²
• Institutional SNPs (I-SNPs): These plans serve beneficiaries who reside in institutions like nursing homes. Enrollment in I-SNPs has remained stable.³²

The dramatic growth in SNPs, particularly C-SNPs, reveals a clear strategic pivot by insurers.

As financial margins tighten in the broad general enrollment market, insurers are increasingly focusing on these high-need, high-revenue populations.

The risk-adjusted payment model provides higher payments for these beneficiaries, creating a business case for insurers to invest in intensive care management programs that can potentially control costs and improve outcomes for these specific groups.

3.4. Behind the Curtain: The Policy and Payment Pressures Reshaping the MA Market

The changes observed in the 2025 MA market—plan consolidation, benefit reductions, and the shift toward SNPs—are not occurring in a vacuum.

They are a direct and rational business response to what analysts describe as the “cumulative impact” of several significant financial and policy pressures that are converging on the program simultaneously.²⁴

The primary drivers of this market shift include:

1. The IRA Part D Redesign: As detailed extensively in Section 1, MA plans are now shouldering a much larger share of the liability for their members’ catastrophic drug costs. This new, multi-billion-dollar financial responsibility is the single largest pressure forcing plans to find savings elsewhere in their benefit design and operations.²⁵
2. The Phase-In of a New Risk Adjustment Model (V28): CMS is in the midst of a three-year phase-in of the new 2024 CMS-HCC risk adjustment model. For 2025, risk scores, which determine plan payments, will be calculated using a blend of 67% from the new, more stringent model and 33% from the older, more generous model.³⁵ This new model is designed to be more accurate and reduce discretionary coding by plans, but its implementation is projected to have a negative 2.45% impact on overall plan revenue.²⁵
3. Increased Healthcare Utilization: Industry reports and plan analyses indicate that healthcare utilization rates have been higher than expected in the post-pandemic period. As beneficiaries seek care they may have deferred, plan costs for medical services have increased, further squeezing financial margins.²⁴

The net effect of these pressures is complex.

Even though the federal government’s total payments to MA plans are still projected to increase by an average of 3.70%, or over $16 billion, in 2025, this aggregate increase is not sufficient to fully offset the combined financial headwinds from the Part D redesign, the risk model transition, and higher utilization.³⁵

This shortfall is what necessitates the strategic retrenchment in benefits and plan offerings that characterizes the 2025 MA landscape.

The Medicare Advantage market appears to be undergoing a critical maturation.

The previous era of “growth at all costs,” which was characterized by a rapid proliferation of plan choices and an ever-richer array of broadly appealing supplemental benefits, is coming to an end.

This phase was fueled by a favorable payment environment and a competitive rush to capture market share.

Now, it is being replaced by a more disciplined, financially-driven strategy focused on profitability, targeted risk segmentation, and a “right-sizing” of benefits.

The confluence of powerful headwinds in 2025—the massive new Part D liability, a less favorable risk adjustment model, and higher-than-expected utilization—has forced a classic business response to margin pressure.

First, insurers are engaging in product line consolidation, trimming their portfolios by eliminating less profitable or duplicative individual plans to reduce administrative overhead and focus resources.

This is evident in the 6.5% decrease in such plans.²⁵

Second, they are implementing cost-cutting measures by reducing the value of some of the most expensive and widely used supplemental benefits, such as comprehensive dental coverage and OTC cards.²³

This directly preserves the rebate dollars that are now needed to fund the new Part D costs.

Third, they are focusing on high-margin segments by doubling down on SNP offerings, particularly C-SNPs, which have seen a 71% surge in enrollment.²⁵

These populations, while costly to care for, also generate higher risk-adjusted payments, offering a pathway to profitability through intensive and targeted care management.

Finally, the explosion in the Part B rebate benefit, now offered to 32% of enrollees, represents a savvy marketing pivot.²⁹

It is a tangible, easily advertised dollar amount that appeals directly to cost-conscious beneficiaries, even as the actual value of other, less visible benefits may be declining.

This is not a sign of the MA program failing, but rather of it evolving into a mature industry where the “wild west” phase of rapid expansion is over.

For beneficiaries, this means the value proposition of MA is becoming more complex.

The choice is no longer simply about accepting network restrictions in exchange for lower premiums.

It now involves a plan-specific calculation of which supplemental benefits have been reduced, by how much, and whether a small monthly Part B rebate adequately compensates for potentially higher out-of-pocket costs for dental care or a smaller allowance for over-the-counter goods.

The MA market is shifting from one of universal “perks” to one of targeted value for specific consumer segments.

Section 4: New Frontiers in Medicare Benefits and Beneficiary Protections

While much of the focus in 2025 is on the financial and structural changes to Medicare, a parallel set of policy-driven enhancements is also taking effect.

These new provisions are aimed at expanding access to care in historically underserved areas, formally recognizing the broader ecosystem of patient support, and improving the overall beneficiary experience.

These changes demonstrate a policy focus that extends beyond pure cost containment and toward a more holistic and person-centered vision of healthcare.

4.1. Expanding Access to Behavioral and Mental Health Care

One of the most significant benefit expansions in 2025 is in the realm of mental and behavioral health, addressing a long-standing gap in Medicare coverage.

A crucial change, which began to take effect in 2024 and will be more fully realized in 2025, allows licensed marriage and family therapists (MFTs) and mental health counselors (MHCs) to enroll as Medicare providers and bill the program directly for their services.⁴

This policy is expected to add tens of thousands of new clinicians to the Medicare provider network, dramatically expanding access to therapy and counseling services, particularly in rural and other underserved communities where such professionals are often the primary source of mental health care.

In addition to expanding the provider base, Medicare is also adding a new level of care.

For 2025, the program will begin covering services provided in “intensive outpatient programs” (IOPs).⁴

This fills a critical gap in the continuum of care for individuals with significant mental health or substance use disorder needs who require more support than a traditional weekly therapy session but do not meet the criteria for a full inpatient hospital admission.

Furthermore, the expanded access to telehealth for mental and behavioral health services, which proved vital during the COVID-19 pandemic, has been made a permanent feature of the Medicare program.⁴

Beneficiaries can now receive these services from their home, regardless of their geographic location.

This stands in contrast to most other medical telehealth services, for which the pre-pandemic requirement of being in a medical facility located in a rural area is set to return on October 1, 2025.⁴

This distinction underscores the high priority placed on ensuring continued, flexible access to mental health care.

4.2. Acknowledging the Ecosystem of Care: New Support for Caregivers

In a landmark policy shift, Medicare is formally recognizing the essential role that family and informal caregivers play in the health and well-being of beneficiaries.

Beginning in 2025, Medicare Part B will provide coverage for certain caregiver training services.⁴

To be covered, the training must be prescribed by the beneficiary’s doctor as a necessary component of their overall treatment plan.

The services are intended to equip caregivers with the specific skills needed to assist the beneficiary with their medical condition or activities of daily living.

As a Part B benefit, these training services will be subject to the standard 20% coinsurance and the annual Part B deductible.⁴

The significance of this change extends beyond the direct financial coverage.

It represents a formal acknowledgment by the Medicare program that a patient’s health outcomes are inextricably linked to the capabilities of their support system.

By investing in caregiver education, Medicare is taking a proactive step to improve the quality and safety of care provided in the home.

This can lead to better patient outcomes, prevent complications such as falls or medication errors, and potentially reduce the need for more costly medical interventions like emergency room visits or hospitalizations.

4.3. Enhancing Transparency and Flexibility: Midyear Notices and Enrollment Updates

The 2025 plan year also introduces new rules designed to improve transparency for beneficiaries and provide greater flexibility for some of the most vulnerable enrollees.

First, Medicare Advantage plans are now required, for the first time, to send a personalized midyear notice to their members.⁸

This communication must detail any of the plan’s supplemental benefits that the member has not yet used during the first six months of the year.

The notice must also include clear information on how to access these unused benefits.

This requirement addresses the common issue where beneficiaries, who may have chosen an MA plan specifically for its extra perks, are unaware of or forget to use them.

The policy aims to improve benefit utilization and help ensure that members are receiving the full value of the plan they selected.

Second, a major change is being implemented to provide greater flexibility for low-income beneficiaries.

Starting January 1, 2025, individuals who are dually eligible for both Medicare and Medicaid, as well as those who receive the Part D Low-Income Subsidy (LIS or “Extra Help”), will have access to a new monthly Special Enrollment Period (SEP).³⁶

This powerful new option allows these beneficiaries to make a change to their coverage once per month.

They can use this SEP to switch from one Medicare Advantage plan to another, move from an MA plan back to Original Medicare and enroll in a stand-alone PDP, or switch between different PDPs.

This provides an unprecedented level of flexibility for a population whose health and financial needs can often change quickly, allowing them to adapt their coverage throughout the year rather than being locked into a plan for a full 12 months.

These new benefits and protections, taken together, represent a subtle but significant philosophical evolution in Medicare policy.

They signal a move away from a purely transactional model of care and toward a more holistic, person-centered approach.

The program is beginning to formally recognize and financially support the broader “ecosystem” of care that surrounds a beneficiary, an ecosystem that includes their mental well-being and the capabilities of their family caregivers.

Historically, Medicare has operated as a fee-for-service system: a provider furnishes a discrete medical service, and Medicare pays for that transaction.

The 2025 changes introduce coverage for services that are not direct medical interventions but are nonetheless crucial to a patient’s overall health.

Covering caregiver training, for example, acknowledges that an untrained caregiver can inadvertently lead to patient complications that result in costly hospitalizations.⁴

Investing a small amount in preventative training supports the entire care unit and can avert greater expenses down the line.

Similarly, dramatically expanding access to MFTs and MHCs recognizes that untreated mental health conditions often exacerbate physical health problems, driving up overall healthcare costs.⁴

This policy moves mental health closer to parity with physical health within the Medicare system.

Even the new MA midyear notice is part of this shift.⁸

It is a response to the reality that supplemental benefits are a key reason people choose MA plans, yet utilization is often low.

This policy moves from simply

offering benefits to actively promoting their use, which is a more patient-centric and value-oriented approach.

These policies, while seemingly smaller in scale than the IRA’s financial overhaul, signal a move toward value-based principles.

They represent a growing understanding that true “health” is a product of medical treatment, mental well-being, a stable support system, and the effective use of all available resources.

This could mark the beginning of a longer-term trend where Medicare invests more in preventative, supportive, and social determinants of health as a strategy to manage long-term costs and improve the quality of life for all beneficiaries.

Section 5: Navigating the New Landscape: A Strategic Guide for 2025

The sweeping changes taking effect in 2025 have created a Medicare landscape that is fundamentally different from that of previous years.

The combination of the landmark Part D redesign, the strategic retrenchment in Medicare Advantage benefits, and the steady rise in Original Medicare costs makes the annual plan selection process more complex and more critical than ever before.

For beneficiaries and their advisors, navigating this new environment requires a heightened level of engagement and a sophisticated, holistic approach to decision-making.

5.1. The Imperative of Annual Plan Comparison in a Year of Unprecedented Change

The annual Medicare Open Enrollment Period, which runs from October 15 to December 7, has always been an important opportunity for beneficiaries to review their coverage.

In 2025, however, it is an absolute imperative.⁹

The sheer magnitude of the changes means that a plan that was an excellent value in 2024 may be a suboptimal or even poor choice in 2025.

Beneficiaries who allow their coverage to automatically renew without a thorough review risk facing unexpected costs, reduced benefits, or changes to their provider networks.

To effectively navigate this period, beneficiaries should undertake several key actions:

• Thoroughly Review the Annual Notice of Change (ANOC): This document, which plans are required to mail to all members by the end of September, is the single most important source of personalized information. The ANOC provides a direct, side-by-side comparison of the plan’s costs, benefits, and rules for the current year versus the upcoming year. It will detail any changes to premiums, deductibles, copayments, the provider network, and the drug formulary.³⁸
• Look Beyond the Monthly Premium: In the 2025 market, the monthly premium is an increasingly unreliable indicator of a plan’s total cost. Beneficiaries must conduct a more comprehensive analysis, comparing total potential costs. This includes examining deductibles, copayments for frequently used services (like specialist visits or hospital stays), the plan’s maximum out-of-pocket (MOOP) limit for medical care, and the specific dollar value and limitations of key supplemental benefits, especially dental and vision coverage.³⁸
• Verify Networks and Formularies: It is crucial to confirm that all of a beneficiary’s preferred doctors, hospitals, and pharmacies remain in their plan’s network for 2025. Similarly, they must check the plan’s drug formulary to ensure all their prescription medications are still covered and to note any new restrictions, such as prior authorization or step therapy requirements.³⁸
• Utilize Official Comparison Tools: The official Medicare Plan Finder tool, available at Medicare.gov, is an indispensable resource. It allows beneficiaries to enter their specific prescription drugs and preferred pharmacies to receive personalized estimates of their annual costs under each available plan. The tool also features the Medicare Star Ratings system, which measures the quality of health and drug services on a one-to-five-star scale, providing a standardized way to compare plan quality and member satisfaction.³⁷

5.2. A Framework for Decision-Making: Original Medicare vs. Medicare Advantage

The fundamental choice between the two main pathways of Medicare coverage—Original Medicare and Medicare Advantage—is more nuanced in 2025.

The recent changes have altered the traditional trade-offs, requiring a careful re-evaluation based on an individual’s health needs, financial situation, and personal preferences.

Original Medicare + Medigap + Stand-Alone Part D Plan (PDP):

• Pros: This pathway offers maximum freedom and flexibility in provider choice, allowing beneficiaries to see any doctor or visit any hospital in the country that accepts Medicare, without needing referrals. When paired with a comprehensive Medigap (Medicare Supplement) policy, it provides highly predictable out-of-pocket costs for medical services. The ability to choose a separate, stand-alone PDP allows for optimizing drug coverage based on an individual’s specific medication needs.
• Cons: This option typically involves higher total monthly premiums, as the beneficiary must pay separate premiums for Part B, their Medigap policy, and their PDP. Original Medicare itself has no annual cap on out-of-pocket spending for medical care; this protection only comes from a Medigap policy. Furthermore, this pathway does not include the bundled supplemental benefits like routine dental, vision, or hearing care that are common in MA plans.⁴⁵

Medicare Advantage (Part C) Plan:

• Pros: MA plans are often attractive for their low or even $0 monthly premiums (beyond the standard Part B premium). They offer an all-in-one, bundled structure that combines medical and, in most cases, prescription drug coverage into a single plan. A key feature is the hard annual cap on medical out-of-pocket costs (the MOOP), which provides crucial financial protection. MA plans are also the primary source of extra benefits like dental, vision, hearing, and fitness program memberships.³¹
• Cons: The primary trade-off is the restriction of provider networks. Most MA plans are Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), which require members to use a specific network of doctors and hospitals to receive the lowest costs.⁴⁷ Care received out-of-network can be expensive or not covered at all (except in emergencies). MA plans also use care management tools like prior authorization, which can create delays or denials of service. As seen in 2025, the value and availability of their supplemental benefits can be reduced by the plan from one year to the next.²⁰

5.3. Unlocking Affordability: A Guide to Extra Help and Medicare Savings Programs

For millions of beneficiaries with limited incomes and resources, federal and state assistance programs can dramatically reduce the costs of Medicare.

In the complex financial environment of 2025, awareness and enrollment in these programs are more vital than ever.

• The Extra Help Program (Low-Income Subsidy – LIS): This federal program provides significant assistance with the costs of Medicare Part D prescription drug plans. It helps pay for Part D premiums, deductibles, and coinsurance. A key expansion of the program in 2024 made full Extra Help benefits available to individuals with incomes up to 150% of the federal poverty level.³ In 2025, beneficiaries who qualify for full Extra Help will pay no monthly premium or annual deductible for their Part D plan. Their drug costs will be reduced to no more than $4.90 for each generic drug and $12.15 for each brand-name drug covered by their plan.³
• Medicare Savings Programs (MSPs): These are state-administered programs that help pay for the costs of Original Medicare. There are four main types of MSPs, each with its own income and resource limits for 2025 ⁴⁸:

• Qualified Medicare Beneficiary (QMB) Program: Helps pay for Part A and Part B premiums, deductibles, coinsurance, and copayments.
• Specified Low-Income Medicare Beneficiary (SLMB) Program: Helps pay for the Part B premium.
• Qualifying Individual (QI) Program: Helps pay for the Part B premium.
• Qualified Disabled & Working Individual (QDWI) Program: Helps pay the Part A premium for certain working individuals with disabilities.

Critically, individuals who qualify for the QMB, SLMB, or QI programs are automatically deemed eligible for and enrolled in the Extra Help program for their prescription drug costs.⁴⁸

Advocacy groups like the National Council on Aging (NCOA) continue to stress the importance of federal funding for programs like the Medicare Improvements for Patients and Providers Act (MIPPA), which supports state and local efforts to conduct outreach and enroll eligible low-income beneficiaries into these essential, cost-saving programs.⁴⁹

The 2025 Medicare landscape marks an inflection point where the “cognitive burden” on beneficiaries to make an optimal coverage choice has reached an all-time high.

The complexity of the interwoven trade-offs has outstripped the capacity of simple heuristics, such as “pick the plan with the lowest premium,” to guide decisions effectively.

Access to sophisticated, unbiased decision support has therefore become more critical than ever.

In the past, the choice was relatively straightforward: pay higher premiums for provider freedom (Original Medicare with a Medigap plan) or accept network limitations for lower premiums and some extra perks (Medicare Advantage).

Now, the number of variables a beneficiary must weigh has multiplied.

They must consider the rising Part B premium against a potential, but often small, MA Part B rebate.

They must balance the value of the new $2,000 drug cap against the reality of higher PDP premiums or increased MA medical MOOPs.

They must calculate whether the specific dollar value of a reduced MA dental benefit is worth more or less than the cost of purchasing a separate dental policy.

The data shows these are not minor adjustments.

MA plans are actively re-engineering their benefit packages, and PDPs are fundamentally restructuring their costs.¹²

The “best” plan is no longer a universal concept but is highly dependent on an individual’s specific health status, prescription drug regimen, tolerance for financial risk, and personal valuation of different benefits.

This complexity creates a significant risk of beneficiaries making sub-optimal choices.

An individual might anchor their decision on the new $2,000 drug cap, not realizing their chosen plan has a much higher out-of-pocket maximum for a potential hospital stay.

Another might be swayed by a $20 monthly Part B rebate, not noticing that their dental coverage has been cut by $500.

This challenging environment creates a new and urgent “market for advice.” The value of unbiased, expert counselors—such as those funded by the State Health Insurance Assistance Programs (SHIPs)—skyrockets.

The importance of sophisticated, government-provided tools like the Medicare Plan Finder becomes paramount.

The role of trusted advocacy and educational organizations also grows in significance.

The future of consumer protection in Medicare may lie less in regulating the minutiae of individual plan features and more in robustly funding and promoting these navigational support systems to empower beneficiaries to manage the overwhelming complexity of the choices they now face.

Conclusion: The Dual Realities of Medicare in 2025 and the Path Forward

The Medicare program in 2025 is defined by a powerful duality.

On one side stands a landmark victory for consumer protection: the Inflation Reduction Act’s reforms have finally placed a hard cap on prescription drug costs, providing unprecedented financial security and peace of mind to millions of Americans who rely on life-saving medications.

This redesign, which simplifies the benefit and eliminates the dreaded “donut hole,” is a generational achievement in health policy.

On the other side, however, is the unavoidable reality of economic adaptation.

The very same reforms that protect beneficiaries have shifted immense financial pressure onto the private insurers that administer Medicare plans.

The result is a landscape of rising costs and strategic retrenchment elsewhere in the system.

Beneficiaries in Original Medicare face higher premiums and deductibles for their medical care.

Those in Medicare Advantage, while still enjoying low premiums, are witnessing the first-ever contraction in the value of popular supplemental benefits and an increase in their potential out-of-pocket liability for medical services.

These two competing narratives—unprecedented cost protection for drugs alongside rising costs and benefit reductions elsewhere—are not contradictory.

They are two sides of the same coin, representing the complex reallocation of risk and resources across the entire Medicare ecosystem.

The system is adapting to the seismic shifts initiated by the IRA.

For the nation’s 65 million Medicare beneficiaries, this new era demands a higher level of engagement and a more sophisticated, holistic approach to choosing coverage than ever before.

The annual Open Enrollment Period is no longer a passive checkpoint but an active, critical exercise in financial and healthcare planning.

The simple heuristic of choosing the lowest-premium plan is obsolete, replaced by the need for a nuanced assessment of total potential costs across medical, drug, and supplemental benefit categories.

The path forward requires a dual focus.

Policymakers and advocates must ensure the robust implementation of the IRA’s protections and continue to fund the vital assistance programs that provide a safety net for the most vulnerable.

Simultaneously, there must be a greater investment in the tools and resources—from the official Medicare Plan Finder to state-based counseling programs—that can help beneficiaries navigate this increasingly complex marketplace.

The long-term effects of these changes—on plan competition, on the health outcomes of beneficiaries, and on the ultimate financial stability of the Medicare program—will be the central story to watch in the years to come, shaping the future of American healthcare for a generation.

Works cited

1. Inflation Reduction Act Medicare Part D changes | UnitedHealthcare, accessed August 5, 2025, https://www.uhc.com/medicare/medicare-education/inflation-reduction-act-part-d-changes.html
2. Biggest changes to Medicare Part D for 2025 – Humana, accessed August 5, 2025, https://www.humana.com/medicare/medicare-resources/medicare-part-d-changes
3. Everything you need to know about Medicare reforms – PAN Foundation, accessed August 5, 2025, https://www.panfoundation.org/everything-you-need-to-know-about-medicare-reforms/
4. Medicare Changes In 2025 – Humana, accessed August 5, 2025, https://www.humana.com/medicare/medicare-resources/medicare-changes
5. HHS Announces Cost Savings for 64 Prescription Drugs Thanks to …, accessed August 5, 2025, https://www.cms.gov/newsroom/press-releases/hhs-announces-cost-savings-64-prescription-drugs-thanks-medicare-prescription-drug-inflation-rebate
6. Selected Health Provisions of the Inflation Reduction Act – Congress.gov, accessed August 5, 2025, https://www.congress.gov/crs-product/IF12203
7. Inflation Reduction Act: Lowering Prescription Drug Prices | Aetna Medicare, accessed August 5, 2025, https://www.aetna.com/medicare/prescription-drugs/inflation-reduction-act.html
8. Medicare in 2025: Key Changes and Updates, accessed August 5, 2025, https://www.medicarerights.org/medicare-watch/2025/01/09/medicare-in-2025-key-changes-and-updates
9. 7 Medicare Changes on the Horizon for 2025 – AARP, accessed August 5, 2025, https://www.aarp.org/medicare/changes-coming-in-2025/
10. 3 Big Medicare Prescription Drug Changes for 2025 – AARP, accessed August 5, 2025, https://www.aarp.org/medicare/future-medicare-drug-payment-changes-2025/
11. A guide to 2025 Medicare Part D – BMS Access Support, accessed August 5, 2025, https://www.bmsaccesssupport.com/assets/commercial/us/bmsaccesssupport/en/pdf/patient-medicare-guide.pdf
12. Medicare Part D in 2025: A First Look at Prescription Drug Plan Availability, Premiums, and Cost Sharing | KFF, accessed August 5, 2025, https://www.kff.org/medicare/issue-brief/medicare-part-d-in-2025-a-first-look-at-prescription-drug-plan-availability-premiums-and-cost-sharing/
13. Final CY 2025 Part D Redesign Program Instructions Fact Sheet – CMS, accessed August 5, 2025, https://www.cms.gov/files/document/fact-sheet-final-cy-2025-part-d-redesign-program-instructions.pdf
14. CMS Reverses Course on Certain Medicare Advantage and Part D Proposals and Further Implements Inflation Reduction Act, accessed August 5, 2025, https://www.sidley.com/en/insights/newsupdates/2025/04/cms-reverses-course-on-certain-medicare-advantage-and-part-d-proposals
15. Fact Sheet: What’s the Medicare Prescription Payment Plan?, accessed August 5, 2025, https://www.medicare.gov/publications/12211-whats-the-medicare-prescription-payment-plan.pdf
16. Understanding the Medicare Prescription Payment Plan – PAN Foundation, accessed August 5, 2025, https://www.panfoundation.org/understanding-the-medicare-prescription-payment-plan/
17. New Medicare Prescription Payment Plan – Cancer Care, accessed August 5, 2025, https://www.cancercare.org/blog/new_medicare_prescription_payment_plan_2024
18. The Ins and Outs of Medicare’s Prescription Payment Plan – Morgan Lewis, accessed August 5, 2025, https://www.morganlewis.com/blogs/healthlawscan/2024/08/the-ins-and-outs-of-medicares-prescription-payment-plan
19. Medicare Advantage and Medicare Prescription Drug Programs to Remain Stable as CMS Implements Improvements to the Programs in 2025, accessed August 5, 2025, https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-medicare-prescription-drug-programs-remain-stable-cms-implements-improvements
20. 2025: A Year of Old Threats and New Opportunities – Medicare Rights Center, accessed August 5, 2025, https://www.medicarerights.org/medicare-watch/2024/12/19/2025-a-year-of-old-threats-and-new-opportunities
21. FAQs about the Inflation Reduction Act’s Medicare Drug Price Negotiation Program – KFF, accessed August 5, 2025, https://www.kff.org/medicare/issue-brief/faqs-about-the-inflation-reduction-acts-medicare-drug-price-negotiation-program/
22. Health Provisions in the 2025 Federal Budget Reconciliation Law – Medicare – 10786 – KFF, accessed August 5, 2025, https://www.kff.org/report-section/health-provisions-in-the-2025-federal-budget-reconciliation-law-medicare/
23. State of the 2025 Medicare Advantage industry: General enrollment …, accessed August 5, 2025, https://www.milliman.com/en/insight/state-of-medicare-advantage-general-enrollment-2025
24. Analysis of the 2025 Medicare Advantage Plan Landscape, accessed August 5, 2025, https://bettermedicarealliance.org/publication/analysis-of-the-2025-medicare-advantage-plan-landscape/
25. Analysis of the 2025 Medicare Advantage Plan Landscape, accessed August 5, 2025, https://bettermedicarealliance.org/wp-content/uploads/2024/10/Analysis-of-the-2025-Medicare-Advantage-Plan-Landscape.pdf
26. 2025 Medicare Parts A & B Premiums and Deductibles | CMS, accessed August 5, 2025, https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles
27. Medicare Part B Premium to Increase in 2025 – AARP, accessed August 5, 2025, https://www.aarp.org/medicare/medicare-part-b-premium-increase-2025/
28. Medicare’s Open Enrollment Period: What you need to know – Humana, accessed August 5, 2025, https://www.humana.com/medicare/medicare-resources/medicare-open-enrollment
29. Medicare Advantage in 2025: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization | KFF, accessed August 5, 2025, https://www.kff.org/medicare/issue-brief/medicare-advantage-premiums-out-of-pocket-limits-supplemental-benefits-and-prior-authorization/
30. Medicare Advantage Changes in 2025 – Wellpoint, accessed August 5, 2025, https://www.wellpoint.com/medicare/understanding-medicare/medicare-advantage-plans-2025-changes
31. Explore 2025 Medicare Advantage Plans (Part C) – Humana, accessed August 5, 2025, https://www.humana.com/medicare/medicare-advantage-plans
32. Medicare Advantage in 2025: Enrollment Update and Key Trends – KFF, accessed August 5, 2025, https://www.kff.org/medicare/issue-brief/medicare-advantage-enrollment-update-and-key-trends/
33. Medicare Advantage 2025 Spotlight: A First Look at Plan Premiums and Benefits | KFF, accessed August 5, 2025, https://www.kff.org/medicare/issue-brief/medicare-advantage-2025-spotlight-a-first-look-at-plan-premiums-and-benefits/
34. Shaping senior care: Trends in Medicare Advantage benefits and coverage from 2022 to 2025 – Milliman, accessed August 5, 2025, https://www.milliman.com/en/insight/shaping-senior-care-trends-medicare-advantage-benefits-2025
35. 2025 Medicare Advantage and Part D Rate Announcement – CMS, accessed August 5, 2025, https://www.cms.gov/newsroom/fact-sheets/2025-medicare-advantage-and-part-d-rate-announcement
36. Medicare Special Enrollment Periods (SEPs) – DHCS – CA.gov, accessed August 5, 2025, https://www.dhcs.ca.gov/Pages/Medicare-SEP.aspx
37. Big Changes Coming to Medicare in 2025: What You Need to Know – Raymond James, accessed August 5, 2025, https://www.raymondjames.com/fiorillofinancialstrategiesgroup/resources/2025/01/22/big-changes-coming-to-medicare-in-2025
38. 5 Actions to Take for 2025 During Medicare Open Enrollment – AARP, accessed August 5, 2025, https://www.aarp.org/medicare/open-enrollment-action-plan/
39. Understanding Medicare Advantage Plans, accessed August 5, 2025, https://www.medicare.gov/publications/12026-understanding-medicare-advantage-plans.pdf
40. Annual Notice of Changes 2025 – United Healthcare, accessed August 5, 2025, https://www.uhc.com/medicare/alphadog/AAOR25LP0230965_000
41. How to Compare 2025 Medicare Advantage plans – eHealth, accessed August 5, 2025, https://www.ehealthinsurance.com/medicare/parts/comparing-medicare-advantage-plans/
42. How to compare Medicare Advantage plans: A worksheet for getting started – Aetna, accessed August 5, 2025, https://www.aetna.com/medicare/understanding-medicare/plan-comparison-tool.html
43. Joining a plan | Medicare, accessed August 5, 2025, https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
44. 2025 Medicare Advantage and Part D Star Ratings – CMS, accessed August 5, 2025, https://www.cms.gov/newsroom/fact-sheets/2025-medicare-advantage-and-part-d-star-ratings
45. Compare Medigap Plan Benefits | Medicare, accessed August 5, 2025, https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits
46. Medicare Coverage Options from UnitedHealthcare, accessed August 5, 2025, https://www.uhc.com/medicare
47. Compare types of Medicare Advantage Plans, accessed August 5, 2025, https://www.medicare.gov/health-drug-plans/health-plans/your-health-plan-options/compare
48. Medicare Savings Programs, accessed August 5, 2025, https://www.medicare.gov/basics/costs/help/medicare-savings-programs
49. Policy Outlook and Priorities for 2025 – National Council on Aging, accessed August 5, 2025, https://www.ncoa.org/article/policy-outlook-and-priorities-for-2025/