Key lessons learned from the 2025 Medicare Annual Enrollment Period (AEP); plus actionable strategies for Medicare Advantage plans looking to improve member experience and reduce costs. 2025 is set to be a pivotal year for Medicare plans nationwide. As the market...

“How much can I expect to pay out of pocket for Medicare coverage?” It’s something you might be wondering if you’re age 65+ or about to turn 65. Medicare expenses are a big concern for many older adults, especially those on a fixed or limited income. The first step to...

Key takeaways: The Medicare Part D coverage gap known as the “donut hole” will end in 2024. As of January 1, 2025, Medicare Part D plans will have a $2,000 out-of-pocket limit. If you reach that threshold, your plan will pay for all of your covered medications in full...

Two important changes are coming for Medicare Part D beneficiaries in 2025 as a result of the Inflation Reduction Act: Annual out-of-pocket (OOP) cap of $2,000 for prescription drugs. Medicare Prescription Payment Plan (MPPP), which will allow beneficiaries who opt in...

Big changes are coming to Medicare in 2025, and they could make a major difference in your prescription drug costs. Thanks to the Inflation Reduction Act, Medicare beneficiaries will see the most significant updates to the program’s drug coverage since it was first...

Last week, the Centers for Medicare & Medicaid Services (CMS) released information about Medicare costs in 2025, including the 2025 premium, deductible and coinsurance amounts for Medicare Part A and Part B. The agency also announced the income-related monthly...

Key components of the Inflation Reduction Act’s Part D reforms will be fully implemented for plans offered in 2025. These changes, including the total elimination of the “coverage gap” coverage period, the establishment of a $2,000 cap on beneficiary out-of-pocket...

Medicare payment rules prohibit coverage for a service if a beneficiary is not financially responsible for the care or if another government entity is obligated to provide or pay for the item or service. For years, the Medicare rules interpreting and implementing this...

A new report from the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Planning and Evaluation (ASPE) examines trends in health care access and outcomes in rural America. While insurance rates in these areas are improving,...

The Inflation Reduction Act (IRA) made significant improvements to Medicare prescription drug access and affordability, including by restructuring the Part D benefit to limit enrollee expenses. Those changes began in January 2024, when the IRA eliminated cost sharing...

Now is the time for people who need health insurance in 2025 to shop for coverage. For those without employer, Medicare, or Medicaid coverage, Healthcare.gov or their state exchange is the place to shop for Affordable Care Act (ACA) plans. Most shoppers will be able...

When the Centers for Medicare & Medicaid Services (CMS) pays Medicare Advantage (MA) organizations, they increase the payments when plans enroll sicker people. This is called risk adjustment, and it is an important guardrail to ensure that all people with Medicare...

Medicare coverage is personal — and changes to those plans and benefits may feel unnerving as it affects one’s overall health and well-being. Originally passed in 2022, the Inflation Reduction Act brought about many changes to Medicare that are now being implemented...

Finding a doctor you like and trust can be a long process, so I understand that it can be frustrating when your doctor no longer accepts Medicare. If your doctor has “opted out” of Medicare, this means that he or she no longer accepts Medicare assignment...

It’s important to plan for your health care needs, but sometimes life throws unexpected curve balls. And when that happens, you’ll need to know what’s covered. Fortunately, there are ways you and your loved ones can get the necessary care at home. Here’s what you need...