Important Updates Every Enrollee Should Know

ltcinsuranceshopper By ltcinsuranceshopper February 3, 2025


Expanded Access to Weight Loss Medications

Medicare cannot cover drugs prescribed solely for weight loss. However, Part D plans can cover well-known weight loss medications, like Ozempic and Mounjaro, when prescribed for other conditions, such as type 2 diabetes.

In March, the FDA approved Wegovy for people with cardiovascular disease who are also overweight. While few Part D plans added Wegovy midyear due to fixed premiums, you may see broader coverage of weight loss medications in 2025.

Subtle Adjustments in Medicare Advantage Coverage

The $2,000 out-of-pocket cap applies to deductibles, copayments, and coinsurance for the drug portion of Medicare Advantage plans.

In 2025, Medicare Advantage plans may make adjustments to balance these added costs. While they’re less likely than Part D plans to change premiums—especially if they don’t charge beyond the Part B premium—plans with zero-dollar premiums are generally safe. The zero-dollar premium is highly attractive and simplifies plan comparisons. However, a plan might adjust its formulary (covered drugs list), reduce its out-of-pocket maximum, increase coinsurance for certain services, or cut back on extra benefits initially offered.

Midyear Statement from Your Medicare Advantage Plan

For the 50.4% of beneficiaries who opted for Medicare Advantage over Original Medicare as of April 2024, the midyear statement will highlight unused benefits. This is valuable information, as these additional perks are often key reasons enrollees choose a specific plan.

Expanded Program for Family Caregiver Services

A program designed for dementia patients and their caregivers, which started this year, will expand fourfold in 2025 to reach more areas across the country.

Named Guiding an Improved Dementia Experience (GUIDE), the program offers a 24/7 support line, a care navigator to help find medical services and community resources, caregiver training, and up to $2,500 annually for respite services such as at-home care, overnight care, or adult day care. Generally, patients and their caregivers will not face copayments for these services.

Efforts to Increase Access to Mental Health Providers in Medicare

While the proportion of adults aged 65 and older using mental health services rose by just 1 percentage point to 20% between 2019 and 2022, as reported in a KFF study, access to care may have influenced these figures.

Previously, licensed marriage and family therapists, mental health counselors, and addiction counselors were unable to bill Medicare because they could not enroll as Medicare providers. However, this year they gained the ability to do so, and some have already begun participating.

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