Blog

What’s New in 2025?

Dec 19, 2024 | Shea Corti

Your Medicare coverage and costs can change each year, so it’s important to understand and review your benefits. Here’s an overview of what’s new in 2025.

Let’s start with Part A costs in 2025:

Part A premium	Free if you’ve worked 10 years or more $285 per month if you’ve worked 7.5 to 10 years $518 per month if you’ve worked fewer than 7.5 years
Part A hospital deductible	$1,676 each benefit period
Part A hospital coinsurance	$0 for the first 60 days of inpatient care each benefit period $419 per day for days 61-90 each benefit period $838 per lifetime reserve day after day 90 in a benefit period (You have 60 lifetime reserve days that can only be used once. They’re not renewable.)
Skilled nursing facility insurance	$0 for the first 20 days of inpatient care each benefit period $209.50 per day for days 21-100 each benefit period

Medicare Part A covers inpatient hospital services, skilled nursing facility services, some home health care, and hospice. Most people don’t owe a premium for Part A, but if neither you nor your spouse have 10 years of Social Security work credits, you may owe a monthly premium. If you’re admitted to the hospital as an inpatient, you’ll owe a deductible of $1,676 at the beginning of your stay. If you have multiple hospitalizations, you may owe the deductible more than once. After you meet your deductible, your first 60 days in the hospital and your first 20 days in a skilled nursing facility cost $0 per day. After that, you owe an out-of-pocket cost each day for your continued stay.

And now Part B costs in 2025:

Part B premium

(For individuals with incomes below $106,000 or couples with incomes below $212,000

$185 is the standard premium

Part B deductible

$257 per year

Part B coinsurance

20% for most services Part B covers

Medicare Part B covers outpatient costs, such as doctor visits and lab tests. In 2025, the standard Part B premium is $185. If your income is above $106,000 as a single person or $212,000 as a married couple, you may pay a higher premium. Keep in mind that if you have a Medicare Advantage Plan, you may also pay an additional monthly premium for being enrolled in that plan. If you have Original Medicare, you‘ll owe a Part B deductible of $257 in 2025. You’ll continue to owe 20% coinsurance for most services covered by Part B.

Your prescription drug coverage costs will depend on your specific plan, but there are some numbers that are helpful for everyone to know in 2025:

National average premium for basic Part D benefit	$36.78 per month
Part D maximum deductible	$590 per year
Catastrophic coverage	$2,000

Medicare Part D covers outpatient prescription drugs. Each year, Part D plans can change the drugs they cover, their pharmacy networks, and their costs. Starting in 2025, your annual out-of-pocket Part D costs are capped at $2,000. After you reach this out-of-pocket limit, you owe nothing for covered drugs for the rest of the year. You’ll have the option to sign up for a payment plan for Part D out-of-pocket costs. The Medicare Prescription Payment Plan, or MPPP, allows you to spread your drug costs throughout the year, with the goal of helping you manage your monthly expenses.

If you have Part D, there’s a good chance that there are significant changes for 2025, because changes to the law that sets up the rules for the Part D benefit made coverage more generous. Medicare is taking steps to stabilize Part D premiums during this transition by limiting the increase in the base premium. In 2025, the national average premium for the Part D basic benefit is around $37 per month.

If your income is limited, you may qualify for help with your Medicare costs. Contact your State Health Insurance Assistance Program, or SHIP, to see if you’re eligible. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

Remember that you have opportunities to change your coverage in 2025.

Many people have to wait until Fall Open Enrollment to change their coverage if they aren’t happy with it. You may have the opportunity to change your coverage earlier in 2025, though, depending on your circumstances. 

If you have a Medicare Advantage Plan, you may be able to use the Medicare Advantage Open Enrollment Period, also known as the MA OEP. You can use this period to switch from your Medicare Advantage Plan to another Medicare Advantage Plan, or to Original Medicare with or without a prescription drug plan. The MA OEP is each year from January 1 through March 31. If you make a change during this period, it will be effective the first of the following month. You may only make one change, so it’s important to choose carefully if you enroll in a new Medicare Advantage or Part D plan. This will automatically disenroll you from your previous Medicare Advantage Plan.

If you have Medicaid, a Medicare Savings Program, or Extra Help in 2025, you have a Special Enrollment Period, or SEP, to enroll in a stand-alone Part D plan or switch between them. This SEP is once per month. If you use this SEP to change your coverage, the change will become effective the first of the following month.
If you have Medicare and Medicaid, you can make a once-per-month change into certain Special Needs Plans that meet federal requirements for integration and that offer a Medicaid plan in your state. This SEP can only be used to enroll in both the Medicare and Medicaid portions of a plan—to align enrollment with an integrated Dual Special Needs Plan, also called a D-SNP, or Applicable Integrated Plan and a Medicaid Managed Care Organization.
If you qualify for another Special Enrollment Period, you may be able to change your coverage. There are several situations when you might qualify for an SEP. For example, if you move outside your plan’s service area, if your Medicare Advantage Plan stopped working with a large amount of its network providers, or if you enroll in certain State Pharmaceutical Assistance Programs. To use an SEP, call 1-800-MEDICARE and explain your situation. If you have questions about your SEP eligibility, contact your State Health Insurance Assistance Program, or SHIP.

Still have questions?  

Your SHIP is here for you! You can contact your SHIP for any Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.

Supplemental Handout

Explore more blogs: