Medicare changes for 2025 are critical for new enrollees as well as existing enrollees to understand. It’s quite common for Medicare changes to happen each year, and being prepared for them allows you to stay ahead of the process and manage your finances more effectively.
To help you do that, we’ve outlined the 2025 Medicare changes here, and make sure to check out existing policy changes that could come from your plan in the year to come.
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What’s New for 2025 in Medicare?
Below, you’ll read the details of the changes to Medicare for 2025. Here’s a quick summary of what you will see:
- Medicare Part A deductibles have increased to $1676 for most people.
- Medicare Part A premium increases to $518 apply to some people
- Medicare Part B premium increases to $185 with an annual deductible increase to $257
- A $2000 cap is in place on out-of-pocket expenses for prescription drug coverage
Medicare Part A Changes 2025
As one of the two components that make up Original Medicare, Medicare Part A offers coverage for inpatient care, such as having to stay in the hospital or a skilled nursing facility, it can include home health care in some situations as well.
Most people – about 99% – do not pay a Part A premium if they have 40 quarters of work contributions. The Part A inpatient hospital deductible paid when admitted to the hospital is $1676 for 2025. That is an increase of $44 from 2024. This deductible covers costs for the first 60 days of covered inpatient hospital care for that benefit period.
Beneficiaries must pay coinsurance of the amount of $419 per day for the 61st5 day of care through the 90th day of hospitalization. And $838 per day for lifetime reserve days. These are also increases from the 2024 figures. Those in a skilled nursing facility pay a daily coinsurance rate for days 21 to 100 of extended care services at a rate of $209.50 for 2025. These 2025 Medicare premiums changes were announced in November of 2024.
| Medicare Part A Deductible and Coinsurance Amounts For 2024 and 2025 by Type of Cost Sharing | ||
| 2024 | 2025 | |
| Inpatient hospital deductible | $1,632 | $1,676 |
| Daily coinsurance for hospital stay days 61-90 | $408 | $419 |
| Daily hospital coinsurance for lifetime reserve days | $816 | $838 |
| Skilled nursing facility daily coinsurance for days 21-100 | $204 | $209.50 |
Medicare Part B Changes 2025
Medicare Part B insurance covers outpatient hospital services, physician care, durable medical equipment, and other health services not provided under Part A. Medicare Part B changes for 2025 are numerous. Consider the following.
The standard monthly premium for enrollees in 2025 is $185. That is an increase of $10.30 from the previous year. The annual deductible for all Medicare Part B beneficiaries is $257, an increase of $17 from 2024 figures. Also, note the Medicare Part B premium in 2025 and deductible increase is due to projected price changes and assumed use increases.
2025 Medicare Part B premium is based on a person’s income. About 8% of people with Medicare Part B will see the following changes to Medicare 2025 if they have income-specific coverage. In those situations, the following Medicare premiums for 2025 follow this chart:
| Income-Related Monthly Adjustment Amounts for Medicare Part B Based on Modified Adjusted Gross Income | ||
| Beneficiaries who file individual tax returns | Beneficiaries who file joint tax returns | Income-related adjustment amount |
| Less than or equal to $106,000 | Less than or equal to $212,000 | $0 |
| Greater than $106,000 and less than or equal to $133,000 | Greater than $212,000 and less than or equal to $266,000 | $14 |
| Greater than $133,000 and less than or equal to $167,000 | Greater than $266,000 and less than or equal to $334,000 | $35 |
| Greater than $167,000 and less than or equal to $200,000 | Greater than $334,000 and less than or equal to $400,000 | $57.00 |
| Greater than $200,000 and less than $500,000 | Greater than $400,000 and less than $750,000 | $78.60 |
| Greater than or equal to $500,000 | Greater than or equal to $750,000 | $85.80 |
Medicare Part B Immunosuppressive Drug Coverage Only
Some people who have a high income only have immunosuppressive drug coverage. In those situations, the following Medicare Part B premiums apply:
| Medicare Part B Immunosuppressive Drug Coverage Based on Modified Adjusted Gross Income | ||
| Beneficiaries who are married and lived with their spouses at any time during the year but who file separate tax returns from their spouses | Income-Related Monthly Adjustment Amount | Total Monthly Premium |
| Less than or equal to $106,000 | $0 | $185 |
| Greater than $106,000 and less than $394,000 | $406.90 | $592 |
| Greater than or equal to $394,000 | $443.90 | $628.90 |
Medicare Part D Prescription Drug Coverage Changes
Medicare Part D prescription drug coverage is an additional policy purchased by those with Original Medicare to help cover the cost of medications. Beginning in 2025, the Inflation Reduction Act will require all Medicare prescription drug plans to offer enrollees the option to pay out-of-pocket for prescription drug costs in the form of a capped monthly installment payment instead of having to pay all at one time at the pharmacy. These are Original Medicare and Medicare Advantage Costs 2024 changes – this option was not available prior to this.
Additionally, there is a Part D manufacturer discount program that starts in 2025 and replaces the existing Coverage Gap Discount Program.
Some of the most significant changes to Medicare Prescription D Coverage include the following:
- Part D has a $2000 cap on prescription drug costs.
- You can opt-in to a maximum monthly cap and use the prescription payment plan to keep monthly costs steady.
- There is no longer a 5% coinsurance for Part D catastrophic coverage.
- There is an expansion of coverage under the federal Extra Help program, which helps those with limited income and assets to pay for prescription medications. This includes no plan deductible, no premiums for Part D drug plans, and no more than $12.15 for each brand-name drug on the plan or $4.90 for generic medications.
- There is no cost sharing for vaccines for enrollees, meaning there is no longer a deductible, coinsurance, or other costs for recommended vaccinations for those with Medicare Part D plans or Medicare Advantage plans.
- Insulin copay is capped at a monthly amount of $35, which includes insulin or a 3-month supply for $105.
Another change for Part D is that there is no longer a donut hole or coverage gap. By getting rid of the donate hole, or the period of time in which you do not have coverage, Part D plans now have a deductible of $590. At that point, you pay copayments for your medications until you reach the out-of-pocket maximum of $2000.
Weight Loss Drug Coverage for Medicare Part B
Additional coverage for weight loss drugs for Medicare recipients was also updated for 2025. Part D plans can now cover most types of weight loss medications when ordered for other needs, such as coverage for Mounjaro and Ozempic for the treatment of type 2 diabetes.
Social Security Medicare Premiums 2025 for IRMAA
For those who have Medicare and are a higher income earner, the Income-Related Monthly Adjustment Amount (IRMAA) you pay in addition to Part B or Part D premium is also updated. According to Social Security, the IRMAA brackets for 2025 are different. The additional premium is a percentage of the national base beneficiary premium of $36.78 for 2025.
The following chart shows you what the 2025 additional premium is based on your income:
| Medicare Part D Additional Premium Based on Income | ||
| Individual Annual Income | Couple Annual Income | Additional Amount owed for Medicare Part D |
| Equal to or below $106,000 | Equal to or below $212,000 | $0 |
| $106,001 -$133,000 | $212,001 – $266,000 | $13.70 |
| $133,001 – $167,000 | $266,001 – $334,000 | $35.30 |
| $167,001 – $200,000 | $334,001 – $400,000 | $57 |
| $200,001 – $499,999 | $400,001 – $749,999 | $78.60 |
| $500,000 and above | $750,000 and above | $85.80 |
Family Caregiver Program Updates
Another change for 2025 is to the family caregiver services program. It is a program for patients and their caregivers who have dementia. Called Guiding an Improved Dementia Experience (GUIDE) it provides:
- 24/7 support line
- Care navigator support services to find help
- Community-based assistance
- Caregiver training
- Up to $2,500 a year for at-home, adult day care respite services and overnight respite
To qualify, a person must be enrolled in Original Medicare and have a formal dementia diagnosis. They cannot be in a nursing home or in hospice care.
Medicare Advantage Costs 2025 Changes
Medicare Advantage is an alternative to Original Medicare. It enables many people to see a more all-in-one solution for their care needs, and it may allow you to tailor your coverage a bit more to your situation. There are some 2025 changes to Medicare Advantage plans you should know about.
For Medicare Advantage plans, the $2000 out-of-pocket spending cap that applies for copayments, deductibles, and coinsurance is applicable. These plans may help you cover your needs and additional expenses. These plans are less likely to have adjusted premiums. To find out if your current plan is hanging, make sure you read through your annual notices from the plan provider.
Changes to Medicare Supplement Plans (Medigap)
In 2021, 14.6 million people receiving Original Medicare selected a Medicare Supplement Plan called Medigap to cover additional costs.
Medicare Advantage plans offer significant savings on prescription drugs and free dental, hearing/vision benefits. Because of this, many Americans are turning to these plans to cover the cost of their medical needs.
It’s important to note that Medicare Supplement plan changes happen often and that change is very locally based. If you are currently using these plans, you may need to update your coverage to match additional coverage needs or to switch plans depending on your needs, health, income, and location.
FAQ
What are Social Security Medicare premiums for 2025?
Premiums paid by beneficiaries in 2025 will be $185 for Medicare Part B coverage for most people, according to Medicare.gov. For those who do not qualify for premium-free Part A, the premium for 2025 is $518 per month.
Who does the Part D prescription drug cap apply to?
In 2025, Medicare introduced a $2000 cap on the costs you have to pay under Medicare Part D coverage for prescription medications. This cap covers all people who are enrolled in Medicare Part D plans. It limits the amount that you have to pay for prescription drugs out of pocket.
It applies to all people. That includes those who have out-of-pocket medication costs that are very high but who do not qualify for the federal Extra Help program. After 2025, expect to see the Part D cap increase annually to account for inflation.
What is the Medicare Prescription Payment Plan?
Another change to Medicare in 2025 is the Prescription Payment Plan, a new tool that aims to make it easier for those who qualify to pay for coverage. It helps to spread out the costs across the year. If you want help to manage your expenses on a monthly basis, consider this plan. It does not necessarily reduce costs, but what it does do is minimize the overall change in costs from one month to the next.
What Are Medicare IRMAA Brackets for 2025?
The IRMAA brackets for 2025 impact those who are high-income earners. Use the following chart to help you to determine where your income falls for 2025:
The following chart shows you what the 2025 additional premium is based on your income:
| Medicare Part D Additional Premium Based on Income | ||
| Individual Annual Income | Couple Annual Income | Additional Amount owed for Medicare Part D |
| Equal to or below $106,000 | Equal to or below $212,000 | $0 |
| $106,001 -$133,000 | $212,001 – $266,000 | $13.70 |
| $133,001 – $167,000 | $266,001 – $334,000 | $35.30 |
| $167,001 – $200,000 | $334,001 – $400,000 | $57 |
| $200,001 – $499,999 | $400,001 – $749,999 | $78.60 |
| $500,000 and above | $750,000 and above | $85.80 |
What Changed with the Donut Hole for Part D Medicare in 2025?
One of the more complex areas of change to Medicare Part D coverage in 2025 relates to what is referred to as the “donut hole.” Before 2025, the following occurred when you needed medications:
- You had to meet your deductible first. That means you paid the full amount of coverage until you met your deductible for the year. In 2024, that was $545.
- Initial coverage went into place next. In this period, you pay copayments, but the amount of those copayments varies by the medication itself.
- A coverage gap was in place. At the point where you reach $5,030 spent on your prescription medications (for 2024), you have reached the donut hole. That means that, during this period, you were less within the coverage gap, which was specifically helpful to those who were paying for brand-name medications and had a dispensing fee. During this period, you pay more out of pocket for the same meds than you did in the initial period.
- Catastrophic coverage applies. Once you reached $8,000 of funds spent on your medication, you reached what was called the catastrophic level of coverage. At this point, Medicare Part D covers all of your prescriptions, meaning that you no longer have to pay out of pocket for those costs.
In 2025, this has all been wiped clean, and a fresh start was put into place. Now, Part D prescription drug coverage has a deductible of up to $590 – depending on the plan you select. You then pay copayments for the medications you need. Those copayments differ for medications. However, once you reach $2000 in out-of-pocket costs, you no longer have to pay for your medications.
This is a big change for this year and one that is very beneficial to many people, if for no other reason than to make this medication plan easier to understand. Keep in mind that your $2,000 maximum in out-of-pocket costs does not apply to your premium payments. You still have to make those each month. Instead, it refers to the copayments and other costs you have to pay for medications.
Get the Medicare Coverage You Need Now
Medicare changes can be frustrating and confusing. Yet, these services are critical to Medicare beneficiaries and ensure they get the care they need. If you have questions, the Medicare Medicaid Services CMS resources in your community can help you. You can also get help from a Medicare insurance agent.
Note the importance of applying for Medicare during the required enrollment periods. Medicare’s 2025 Open Enrollment Period runs from October 15 to December 7 each year.
Note that there are other times when you may qualify to enroll in Medicare coverage, including the 3 months before and three months after you reach the age of 65. It is critical to act quickly during this time to ensure you have the time you need to choose the right Medicare plans for your needs. Compare your Medicare options now and learn more about plans that may fit your needs.
How to Get Help Now
Schedule a consultation with a licensed insurance provider or use the tools on this page to get updated details about the Medicare changes that are applicable to you and what plans may fit your needs.
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