Do Not Skip Reshopping for 2025 during the Open Enrollment Period
Well, this year’s Medicare Open Enrollment Period is loaded for bear. It is definitely not the year to skip reshopping your Part D plan. The window to reshop your Part D plan is open only between October 15 and December 7.
The sheer number of changes for 2025 is staggering. Every person with a Part D plan is in for some shocking news. For some, it will be a positive shock. For most, not so much. As one gentleman wrote to me after one of my articles was published in Retirement Daily, “This news is like getting a prostate exam every month!”
Prepare for mayhem and misery
Many folks have been used to low-cost drug plans. There were lots of fifty-cent premiums in 2024. For many, 2025 will end all that. In addition, you may find your Part D plan has disappeared entirely. Or your Medicare Advantage plan may no longer be available in your area. Not to mention you might not have a $2,000 cap on your out-of-pocket drug costs.
You will notice these changes. So, make sure you reshop your Part D plan before December 7th. If your Part D plan is wrapped in a Part C / Medicare Advantage plan, you need to reshop that plan as well.
If you are new to Medicare and considering a Medicare “Advantage” plan, please do extra research this year. These plans are not what they seem on the surface. Read Is a Medicare Advantage Plan Right for You before making a move in that direction.
After December 7th, you are locked into the plan on record for all of 2025. (Unless you were affected by those terrible hurricanes that came rip-roaring through the south earlier this summer.)
Standalone Part D plans shrink to lowest number ever offered
In a stunning move, private insurers have shut down or consolidated boat loads of standalone Part D plans (PDP). The result for 2025 is there will be 524 PDPs offered—a 26% decrease from 2024. And a rock-bottom number offered since Part D plans first came on the scene in 2006.
Take a look at the KFF report on Part D plans for some amazing visuals. Insurance companies were anxious to offer Part D plans when initially available. There were 1,429 back in 2006. Today, only 524 plans survive. Each person, on average, will have about a dozen plans to choose from. But the fewer the players, the higher the costs for all of us.
If you live in Florida, Massachusetts, or New Hampshire, the number of standalone Part D plans offered for 2025 is 14. That’s a drop of 6 plans from 2024 when you had 20 plans to choose from.
Make sure to reshop your Part D plan for 2025!
Part C plans (Medicare Advantage) pulling out of many counties
On top of fewer Part D plans, there are also slightly fewer Part C plans with Part D wrapped in (MAPD). Each person, on average, will still have a ridiculous 42 Part C plans to try to decipher and choose from.
Depending where you live, you could see Medicare Part C plans pulling out of your area. Three of the largest insurance companies are looking for higher profits going into 2025. To achieve Wall St. expectations, they are shutting down their Medicare Advantage offerings in many counties and regional areas.
This leaves vulnerable seniors trying to figure out what they are going to do next for health insurance. And how to find new doctors. Or keep the ones they want even though it means paying more.
Humana will stop offering Medicare Advantage in 13 counties in 2025, a move that will affect some 560,000 beneficiaries. That’s 10% of seniors who chose Humana’s Part C plans.
Cigna is exiting Medicare Advantage markets or making service area reductions in eight states for 2025, affecting about 5,400 members.
CVS/Aetna announced it is planning to lose approximately 10% of its 4.2 million MAPD customers. Cuts will come across many counties in many states. And is likely to continue next year.
Lots of smaller MAPDs shutting operations
Thanks to a journalist at Becker’s Payer Issues, here is the list of Part C plans pulling out of other markets. This move affect hundreds of thousands of seniors, and also illustrates how insurance companies drive access to health insurance. It is up to every older American to stay on top of these out-of-the-clear-blue changes.
Here’s the list of insurers pulling out of Part C in some capacity (MAPD = Medicare Advantage with Part D plans):
- In OREGON, Moda Health will no longer offer MA plans. It’s discontinuing all individual Medicare Advantage plans for 2025.
- In Washington State, Premera Blue Cross will stop its MAPDs in 2025. 32,000 seniors who chose this MAPD need to find a new plan ASAP.
- In VERMONT, MVP Health Care and University of Vermont Health shuttered their joint Medicare Advantage plan for 2025.
- In TEXAS, Southwestern Health Resources, Care N’ Care, a regional MAPD will close up shop for some 26,000 seniors.
- In NEW MEXICO, Centene’s WellCare MAPD will wreak havoc on nearly 12,600 seniors. In total, Wellcare’s MAPD will cease in five more states: Alabama, Massachusetts, New Hampshire, Rhode Island, and Vermont, affecting another 27,000 seniors.
- In ARIZONA, Blue Cross Blue Sheild of Arizona will not offer MAPDs in 2025.
- In SOUTH CAROLINA and VIRGINIA, Clear Spring Health is withdrawing its Medicare Advantage prescription drug plans. But it plans to continue MAPDs in Illinois, Georgia, and Colorado.
- In KANSAS and MISSOURI, BCBS Kansas City is exiting the Medicare Advantage market at the end of 2024, impacting some 30,000 seniors.
Premiums up in many areas…
Unless you live in New Hampshire or Maine, New Englanders should expect their lowest Part D plan premium to be higher in 2025. By over 2000%! That’s crazy, right?
The same Part D plan is the lowest cost provider in 2025: Wellcare Value Script. But in four of the little states, the monthly premium jumped from fifty cents to $12.40! But in ME and NH, the fifty-cent premium from last year dropped to $0 for 2025. What is going on out there?
My favorite (tongue-in-cheek) situation is between New York and New Jersey. Take a look at how different the premiums are between 2024 and 2025. And the huge benefit those in NJ are getting versus their neighbors just over the border. Many in NJ will pay $27 in premiums for the year while New Yorkers get hit with a walloping $464!
And then there’s the west coast
Don’t worry, California and Alaska. Plenty of shenanigans to go around in your neck of the woods, too.
If you aren’t reshopping your Part D plans, you’ll miss out on much, much lower premiums. But only if you know to change your Part D insurer.
In Alaska, you can find a $0 premium plan. But you must switch from last year’s cheapest plan (Wellcare Value Script) to this year’s cheapest plan (Humana’s Basic Rx). That move will save you $267.
For the Californians who are reading this, your lowest cost plan isn’t quite $0. But if you switch to Cigna Healthcare Assurance, the lowest premium is $1.80.
It’s important to note that the Rx’s you take may not fit into these lowest premium plans. The bigger point is that everything is moving, shifting, and shaking. And it’s up to you to figure out the best plan for you for 2025.
…And formularies down
Another big caution for you: each Part D insurer can change the drugs it covers. And, boy, have the insurers been reducing the number of drugs they cover. This happens whether you have a standalone Part D plan, or one wrapped in a Part C plan.
The folks at GoodRx (the discount coupon company) just released a terrific view of drug coverage in Part D plans. Topline, here’s what they found:
- In 2010, Part D plans covered 73% of the prescription drugs on the market.
- In 2024, Part D plans covered only 54%—a 19% decrease in coverage for seniors.
Furthermore, they looked at how many drugs now carry restrictions such as limits on quantities, step therapy, and/or prior authorization. They found:
- In 2010 only 27% of all drugs required some sort of restriction.
- In 2024, 50% of all drugs make it hard for seniors to get what they need.
Reshop your Part D plan right away
This is serious stuff. It is unconscionable that Part D plan insurers and the federal government force seniors to try to navigate this ridiculously complex system. But that is in fact what is going on.
Older retirees who need medications are at the mercy of an online tool to help them sort through the layers of complexity. Or they turn to brokers who sell them MAPDs, limiting their options and flexibility for care. But increasing commissions for the brokers.
And if they don’t reshop their Part D plans, they’ll just pay a whole lot more. Oh well. You should have known you’re buying a one-year contract. It’s on you to read the horribly laid out ANOC (annual notice of change). And you should be able to navigate the online tools that will give you 12 standalone Part D plans to compare. And 42 Medicare Part C plans to shift through.
Honestly, who does this to our seniors? And that now includes you! You are on the hook to figure this stuff out in very short order. You need to reshop your Part D plan, ideally by November 1st.
Steps for using the Medicare.gov “find plans” tool
It is relatively easy to reshop your Part D plan once you get a hang of the “find plans” tool on Medicare.gov. But it’s not fast if you have more than two or three drugs.
Steps to take:
- Set up your myMedicare account on Medicare.gov. This is where you can enter and save your Rx’s.
- Enter the find plans tool using your zip code and county.
- Click on “Medicare Drug Plan (Part D).”
- Answer the question if you use any extra help programs.
- Enter every prescription you take – the exact drug name and dosage.
When you are done adding all your drugs, it is critical that you shop for the right pharmacy. Not the pharmacy you’d like to use. Or the one you’ve used for the last 30 years. It’s all about finding a Preferred, In-Network pharmacy. That’s where you will find your lowest overall costs.
Mail order is often the lowest cost, but not always.
A helpful tip
When you are done selecting your pharmacies, you’ll get a list of all the Part D plans available to you in your zip code. Click on the blue “Plan Details” box to get into the guts of the results. This is where you’ll see your Rx costs at each of the pharmacies you’ve selected. You’ll also see if one or more of your drugs is not covered by the specific Part D formulary.
Spend some time playing around with this tool. It is incredibly powerful.
You can choose five pharmacies at a time. Select Mail Order, CVS, and Walgreens. At least one of these will be preferred, in-network.
Then try to find a pharmacy that is Out-of-Network. You want to see how much you would pay at retail cost. That happens if you didn’t have the right combination of Part D plan + your drugs + the formulary + preferred pharmacy. It’s a shocker!
Here’s an example so you know what I look for
For this example, I used four drugs. Some are generics, some brand. Using the “find plans tool,” I found the lowest cost Part D plan for the premium plus drug costs.
You can see the lowest cost of these particular drugs comes with mail order at $1,629 for the year. But if you always pick up your prescriptions when you grocery shop at Big Y, you’ll pay a whopping $14,426!
Shop very carefully!
These are just the drug costs. You’ll still need to pay a monthly premium. In this example, the Cigna Healthcare Saver Rx plan, the premium is $28.80. In zip code 02360, Plymouth Co. Massachusetts, it was the lowest overall cost plan.
Mark your calendar for November 1st to reshop your Part D plan. I’m pretty sure you will be glad you did. Especially this year. So many pieces of these Part D plans have changed. And you don’t want to pay more than you absolutely have to. Good luck!
Last note of encouragement
Get this mess out of the way before the holidays. You don’t want to be pulling your Thanksgiving turkey out of the oven and worrying about Medicare. “Oh no! I need to hold dinner so I can reshop my Part D plans!” is not a strategy!
Take your time to reshop your Part D plan. You can do it!
