Here's what Nebraska seniors need to know during upcoming Medicare open enrollment

While year-to-year changes are typical for Medicare drug coverage and Medicare Advantage plans, some bigger changes are in store for both in 2025.

As a result, seniors should make sure they review their coverage during the annual open enrollment period that begins Tuesday and continues through Dec. 7, said Mike Carsey, a volunteer with Volunteers Assisting Seniors.

During that window, seniors can join, switch or drop a Medicare plan or change Medicare Part D drug coverage or Medicare Advantage plans for the coming year.

Volunteers Assisting Seniors serves as the east-central Nebraska office of the federally funded Nebraska State Health Insurance Assistance Program, covering Douglas, Sarpy, Cass, Washington and Dodge Counties. The office, like others across the state, is staffed by trained and certified volunteers who provide free, unbiased consultations with Medicare-eligible clients who want help comparing plans.

Carsey said the biggest change for the coming year is that the Inflation Reduction Act of 2022 will end the Medicare Part D coverage gap, sometimes referred to as the doughnut hole.

As a result, Medicare beneficiaries' yearly out-of-pocket expenses for medications will be capped at $2,000, he said.

The change, however, is expected to affect fewer than 5% of Medicare-eligible beneficiaries, he said, because not all take expensive medications.

A lot of beneficiaries may think that means that they don't need to review their plans for next year, Carsey said. But the cost of medications and the cost of plans can change every year, even if beneficiaries' medications don't.

"They still want to get the best deal they can even if they're spending significantly less than $2,000," he said.

Plans also are responding to changes under the act, which requires both plans and drug manufacturers to bear a greater share of the cost of medications, he said.

Some stand-alone drug plans are withdrawing from the market and others are reducing the medications they cover, Carsey said. There were 21 Part D prescription drug plans in the Omaha area this year. Next year, the list will decrease to 14.

"People still need to be aware of what's going on, this year more than ever, and make sure the plan they have is still the best plan for them for next year," he said.

Premiums, limits may increase

Carsey said staff also have seen premiums for some stand-alone Part D plans increase significantly for next year. One increased by $35 a month, and another decreased $25 a month. Premiums for the 14 that will be offered in eastern Nebraska next year range from zero to $117.40 a month.

"That's why you want to shop around, even when your medications don't change," he said.

For the next year, the highest deductible for a Medicare Part D prescription drug plan will be $590, up from $545 last year. While that's the maximum set by the government, many plans will have lower deductibles based on the mix of medications a beneficiary uses and the pharmacy they select.

Most Medicare Advantage plans also include drug coverage, he said. Some of those are adding deductibles to their drug plans that they didn't have before.

Volunteers Assisting Seniors staff also have noticed increases in both in-network and out-of-network out-of-pocket limits on health coverage under some Medicare Advantage plans, he said. It's not clear, however, whether that's connected to the inflation act. There will be 29 Medicare Advantage plans in the Omaha area next year, up from 28 this year.

Medicare Advantage participants, he said, also should check each year whether their providers still accept their plan. That, too, can change from year to year.

But beneficiaries shouldn't pick a plan based on premium alone. The volunteers will use the Medicare.gov plan finder to help them identify the least-expensive option from a total cost standpoint, including premiums and medications.

Going through the process can pay off. Last year, the local group helped about 1,700 people review their coverage, saving beneficiaries approximately $1.3 million.

If beneficiaries like their plans, they can keep them. If they don't make a change, their current plan will roll over automatically next year.

While Medicare now has negotiated prices for 10 high-cost drugs, Carsey said, those prices won't go into effect until 2026. Prices for additional drugs will be negotiated every year for the next several years.

During open enrollment, Volunteers Assisting Seniors will offer telephone and in-person counseling appointments at its office, 900 S. 74th Plaza, Suite 403, as well as in-person appointments at events throughout the community. To make an appointment or find a meeting, call 402-444-6617 or find the 2024 event calendar at https://vas-nebraska.org/services/medicare-2/open-enrollment/

To contact other groups around the state, call 800-234-7119.

Nebraska hospitals urge seniors to examine Medicare options, be cautious of Medicare Advantage