Starting October 15, Medicare Advantage renewal period begins. During this time, you can compare your current plan with the plans announced by Sharo and, if necessary, switch to a better plan.
We spoke to John Kim Insurance, which has been handling Medicare insurance in Northern California for the past 20 years, about the major changes this year. There will be significant changes in 2025, both in the Dual Eligible Special Needs Plan (D-SNP) and in the prescription drug sector.
The scope of D-SNP (Medicare and Medi-Cal) benefits will be expanded, with a significantly increased monthly income limit of $1,752 for singles and $2,372 for couples, and no asset limit. Therefore, it will be a good opportunity for those who are burdened with Medicare Part B premiums.
The coverage gap, known as the donut hole, will be eliminated by setting a $2,000 cap on out-of-pocket expenses for beneficiaries, even if they are not Medi-Cal beneficiaries. In other words, once a beneficiary’s out-of-pocket expenses reach $2,000, the initial coverage phase will be over, and the beneficiary will reach a catastrophic level where they will not pay anything.
Currently, if you sign up for additional insurance such as Part C, there is no deductible or the initial coverage amount, which is equivalent to 25%, is significantly reduced. For example, there is no or very low copayment for Tier 1 and Tier 2 prescription drugs. Also, starting in 2025, Part D insurers must offer all enrolees the option to pay their share of the cost (including deductible, copayment, and copayment) in monthly instalments over the plan year, rather than paying the full amount at the time of service (e.g., at the pharmacy).
This program is available to all enrolees, but it may be more beneficial for those who have a high out-of-pocket cost early in the plan year. Since Medicare insurance, including Medicare Advantage Insurance, offers a variety of options depending on each enrolee’s situation, it is important to discuss it directly with your agent, said John Kim.