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Medicare Advantage Plans Changes In 2025 And Beyond
What To Know About Medicare Advantage Changes In 2025 And Beyond
Medicare Advantage changes offer enhancements for Medicare members:
- Changes to Medicare prescription drug costs and payments
- Improvements to dual-eligible special needs plans
- More awareness of Medicare Advantage supplemental benefits
- Better access to behavioral healthcare providers
Overall, federal Medicare Advantage changes help insurers like Anthem provide better Medicare Advantage plans.
What Are The Changes To Medicare Advantage Plans In 2025 And Beyond?
Medicare Advantage Plans (Part C) are changing. Here is what you need to know if you’re an existing member or planning to enroll.
Medicare prescription drug costs and payments
In 2025, Medicare Part D plans and Medicare Advantage plans that include prescription drug coverage will feature lower out-of-pocket cost limits and new payment options. Changes include:
- Annual out-of-pocket cap reduced from $8,000 to $2,000
- Elimination of the Medicare donut hole in 2025
- Out-of-pocket prescription drug payments can be spread throughout the year in monthly installments
Learn more about Medicare Part D 2025 changes
Integrated care for dual-eligible special needs plan (D-SNP) enrollees
There are two important Medicare Advantage changes in 2025 that will impact D-SNP members. First, you might qualify for an integrated D-SNP, which coordinates care and benefits for both Medicaid and Medicare through the same health plan. This integrated care may improve health outcomes and cost savings for members.
Second, if you’re already enrolled in a D-SNP plan, you may be able to change plans monthly, depending on your current plan type.
Notifications about Medicare Advantage supplemental benefits usage
Starting in 2026, insurance companies that provide Medicare Advantage plans, like Anthem, will need to let their members know about unused supplemental benefits. The mid-year notification will be personalized to each Medicare Advantage member with a list of supplemental benefits not used or underutilized by the member during the first six months of the year. The change will help members use the full benefits of their Medicare coverage.
More access to behavioral healthcare
In 2025, changes to Medicare Advantage plans will include better coverage for mental healthcare, too. Key changes include expanding the behavioral health network by allowing marriage and family therapists and mental health counselors to enroll as Medicare providers. An intensive outpatient program will also be launched that fills the gap between outpatient and hospital-level care, so those who fall between categories receive the care they need.
Is A Medicare Advantage Plan Right For You?
With all these changes, now is a good time to review your options for a plan that best meets your needs in 2025. Anthem Medicare Advantage plans include the same coverage as Original Medicare (Parts A and B), and may include additional benefits like these:
- $0 or low monthly premiums
- Prescription drug coverage (Part D)
- Dental, vision, and hearing coverage
- Allowances for over-the-counter health items, groceries1, 2, and utilities1, 2
- SilverSneakers® fitness program
And you’ll have a dedicated support team to help you get the most out of your plan. Benefits may vary by where you live and the plan you choose.
Compare Medicare Advantage and Original Medicare
Am I Eligible For A Medicare Advantage Plan?
If you are turning 65 and applying for Medicare for the first time, you can choose a Medicare Advantage plan during your Initial Enrollment Period (IEP). This is a seven-month period that includes:
- Three months before your 65th birthday month
- Your 65th birthday month
- Three months after your 65th birthday month
Once you’re enrolled in Original Medicare, you can sign up for a Medicare Advantage plan during the Medicare Annual Enrollment Period, which occurs October 15 to December 7. You may also be eligible for a Special Enrollment Period if you experienced a qualifying life event, like a move or loss of coverage.
Let us help you navigate the changes to Medicare Advantage plans in 2025. You can count on our experience and support to find a plan that’s right for you.
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Why Choose Anthem?
1 Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of approved groceries and utilities. Unused amounts will expire at the end of the month or quarter.
The Benefits Mastercard® Prepaid Card is issued by The Bancorp Bank N.A., Member FDIC, pursuant to license by Mastercard International Incorporated and card can be used for eligible expenses wherever Mastercard is accepted. Valid only in the U.S. No cash access. This is not a gift card or gift certificate. You have received this card as a gratuity without the payment of any monetary value or consideration.
2 Depending on your plan, the benefits listed may be available through the Medicare Advantage Value-Based Insurance Design Model or to eligible members as Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you have a high risk for hospitalization and require intensive care coordination to manage chronic conditions such as Chronic Kidney Diseases, Chronic Lung Disorders, Cardiovascular Disorders, Chronic Heart Failure, or Diabetes. For a full list of chronic conditions or to learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to Chapter 4 in the plan’s Evidence of Coverage.
The SilverSneakers fitness program is provided by Tivity Health, an independent company. Please talk to your doctor before starting an exercise program. SilverSneakers, the SilverSneakers shoe logo type and SilverSneakers Flex are registered trademarks of Tivity Health, Inc. © 2025 Tivity Health, Inc. All rights reserved.
Anthem Blue Cross and Blue Shield, a Medicare Advantage Organization with a Medicare Contract in Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, New Hampshire, Nevada, New York, Ohio and Wisconsin, offer HMO, HMO D-SNP, HMO C-SNP, HMO I-SNP, LPPO, LPPO D-SNP and/or RPPO. Anthem Blue Cross and Blue Shield offers PDP plans in Colorado, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. Anthem Blue Cross and Blue Shield HMO D-SNP and LPPO D-SNP plans contract with state Medicaid programs. Anthem Blue Cross and Blue Shield Retiree Solutions, a Medicare Organization with a Medicare Contract in New York, offers LPPO plans. Enrollment in Anthem Blue Cross and Blue Shield and Anthem Blue Cross and Blue Shield Retiree Solutions plans depend on contract renewal.