7 medicare changes happening right now in 2025

THE DEVIL’S IN THE DETAILS. Even after the new year, you should review your plan’s annual notice of change carefully. Don’t just rely on the general description of coverage in the Medicare

Plan Finder. Look at the details in the Explanation of Benefits on the plan’s website. Also reconfirm that your providers are in the plan’s network. 5. MIDYEAR STATEMENT FROM YOUR MEDICARE

ADVANTAGE PLAN This will matter to Medicare beneficiaries who have chosen Advantage plans instead of original Medicare, 50.5 percent as of September 2024. The midyear statement will show

available benefits that you haven’t used — important since those extras are often what persuades a Medicare enrollee to sign with a particular plan. “For example, if they haven’t used any of

their dental, vision, hearing or fitness benefits, plans are required to notify them if they have any benefits left,” Jacobson says. You’ll continue to see more realistic TV ads from

Medicare Advantage plans, the private insurance alternative to original Medicare. Rules that took effect in 2023 before open enrollment prohibited Medicare Advantage ads from mentioning

benefits not available in the area where the ad appears. The ads also can’t mislead you into thinking you’re contacting a government employee when you call with questions. Jason Schneider 6.

EXPANDED PROGRAM FOR FAMILY CAREGIVER SERVICES A program for dementia patients and their caregivers that launched last year will quadruple in 2025, serving more of the country. The program,

called Guiding an Improved Dementia Experience (GUIDE), provides a 24/7 support line, a care navigator to find medical services and community-based assistance, caregiver training and up to

$2,500 a year for at-home, overnight or adult day care respite services. Patients and their caregivers typically won’t have copayments. ADDING 294 TO ORIGINAL 96. CMS selected 96

organizations to participate starting July 1, 2024, including academic medical centers, hospitals, small and large group practices and community-based organizations already providing

programs for dementia patients. The agency chose 294 organizations to join in July. “We’re very excited about this,” says Janet LeClair, CEO of Memory & Movement Charlotte (North

Carolina), a nonprofit medical practice that has focused on dementia patients for 11 years. “The caregiver is really the pivotal person ensuring the quality of life of the patients.”

IMPORTANT CRITERIA. Participants must be enrolled in original Medicare and have a dementia diagnosis. They can’t be in hospice or a nursing home. “We know intuitively that respite is so

critical to the health and well-being of the caregiver, which directly correlates to the health and wellness of the patient,” LeClair says. To see if a program is available in your area, go

to the CMS GUIDE program fact sheet and the link to the CMS Innovation website. Click GUIDE MODEL in the drop-down models list | DISPLAY SELECTED. Programs that will begin in July 2025 are

listed. Contact the program to learn more about eligibility and request an assessment. 7. A PUSH TO ADD MORE MENTAL HEALTH PROVIDERS TO MEDICARE Although the percentage of adults 65 and

older reporting they used mental health services increased by only 1 point to 20 percent from 2019 to 2022, according to a KFF study, access to care may have affected those numbers.  Before

2024, licensed marriage and family therapists, mental health counselors and addiction counselors couldn’t bill Medicare because they weren’t allowed to enroll as Medicare providers. Now they

can, and some have. A PAPERWORK PROCESS. “But it’s not just automatic. There are steps they need to take,” Freed says. Medicare Advantage plans must meet stricter standards to improve

access to behavioral health specialists. “We’ve had such tremendous excitement and interest with tens of thousands of clinicians enrolling in the Medicare program, which will make a big

difference for access to care,” Seshamani said. More than 400,000 behavioral health clinicians nationwide are eligible, but you’ll need to ask any provider you seek if they accept Medicare.

POSITIVE DEVELOPMENT: Even though many telehealth expansions that took effect during the COVID-19 pandemic were to expire at the end of 2024, Medicare permanently expanded access to

telemedicine for behavioral health services. That can help with access to providers, especially in rural areas. And a budget bill that Congress approved in late December to keep the

government running until mid-March extended the telemedicine provisions in effect since 2020.