Many older Americans buying health insurance this fall will face reduced benefits and changes in coverage. Assuming their plan is still available in 2025.
More than a million people will likely need to find fresh coverage as major insurers cut costs and withdraw from markets for Medicare Advantage plans, the privately run version of the federal government’s insurance program aimed primarily at people age 65 and older.
Industry experts also predict some price increases for Medicare prescription drug plans as needed improvements in coverage occur.
Voters will learn about the insurance changes just weeks before the next president is elected and as Democrat Kamala Harris begins her campaign promising to lower health care costs. Early voting has already begun in some states.
“This could be bad news for Vice President Harris. If that premium goes up, that’s a clear sign that you’re paying more,” said Massey Whorley, an analyst at healthcare consulting firm Avalere. “This has significant implications for how they view the performance of the current government.”
Insurance agents say the election distraction adds another complication to an already tough annual enrollment window that begins next month.
Insurers are pulling out of Medicare Advantage
According to the federal government, Medicare Advantage plans will cover more than 35 million people next year, about half of all Medicare enrollees. Insurance agents expect more people than usual will need to buy fresh insurance in 2025 because their insurer has either terminated a plan or exited its market.
Health insurer Humana expects more than half a million customers — about 10% of its total — will be affected as it withdraws Medicare Advantage plans in locations across the country. Many customers may switch to other Humana plans, but company leaders still expect to lose a few hundred thousand customers.
CVS Health’s Aetna is forecasting a similar loss, and other major insurers have said they are leaving several states.
Insurers say rising costs and care utilization as well as government reimbursement cuts are forcing them to retreat.
Some people can expect a tough search
When insurers exit Medicare Advantage markets, they tend to stop selling plans with lower quality ratings and those with a higher proportion of Black buyers, Dr. Amal Trivedi, a public health researcher at Brown University.
He noted that market exits can be particularly tough for people with multiple doctors and for patients with cognitive problems such as dementia.
There are still dozens of plan options in most markets. However, finding a fresh option requires understanding the out-of-pocket costs for each option and figuring out how doctors and regular prescriptions are covered.
“People don’t like change when it comes to health insurance because you don’t know what’s on the other side of the fence,” said Tricia Neuman, a Medicare expert at KFF, a nonprofit that researches health care busy.
Plans that don’t leave the markets may raise deductibles and reduce benefits, such as: B. Cards used to pay for utilities or groceries.
These proved popular in recent years as inflation rose, said Danielle Roberts, co-founder of insurance agency Boomer Benefits in Fort Worth, Texas.
“It’s really difficult for someone on a fixed income to choose a health insurance plan for the right reasons … when $900 on a Flex card in free groceries sounds pretty good,” she said.
Don’t oversleep when choosing a Medicare plan
Prices could also rise for some so-called standalone Part D prescription drug plans that are combined with customary Medicare coverage. KFF states that the population is more than 13 million people.
The Centers for Medicare and Medicaid Services said Friday that premiums for these plans will fall by an average of about 4% to $40 next year.
However, brokers and agents say premiums can fluctuate widely and still expect some increases. They also expect less plan choice and changes to formularies or lists of covered medications. Roberts said she has already seen premium increases of $30 or more for some plans next year.
Any price change will hit a customer base known to switch plans for premium changes starting at $1, said Fran Soistman, CEO of online insurance marketplace eHealth.
The changes come when a coverage revision approved by Congress takes effect. Specifically, it will cap out-of-pocket drug costs for Medicare recipients at $2,000, an initiative that Democrats and President Joe Biden have targeted in 2022.
In the long term, these changes will result in “much greater benefit,” Whorley said.
KFF’s Neuman noted that the cap on drug costs will be particularly helpful for cancer patients and others with costly prescriptions. She estimates that around 1.5 million people will benefit.
To head off acute spikes in premiums because of the changes, the Biden administration will withdraw billions of dollars from the Medicare trust fund to pay insurers to keep premium prices low, a move that some Republicans have criticized. Insurers will not be allowed to raise premium prices beyond $35 next year.
People can sign up for 2025 coverage between October 15 and December 7. Experts say the potential changes mean it’s vital for consumers to closely examine any fresh options or insurance policies they want to renew.
“This is not a year to sleep on, you just have to get back to the status quo,” said Whorley, the health care analyst.
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The Associated Press Health and Science Department receives support from the Science and Educational Media Group of the Howard Hughes Medical Institute. The AP is solely responsible for all content.
