Key Takeaways

• Medicare Part C plans in 2025 are experiencing structural and benefit-related changes that go beyond monthly premiums. These shifts may directly affect how you access care, receive prescriptions, and use supplemental benefits.

• Understanding these updates now can help you avoid unexpected costs or coverage gaps during the year—and may even prompt you to explore different plan options during the next Open Enrollment period.

Expanded Coverage Isn’t Always the Whole Story

While many Medicare Advantage (Part C) plans in 2025 still promote additional benefits like vision, dental, or hearing coverage, several of these features now come with tighter restrictions. Some benefits have been reduced, and others require prior authorizations that weren’t needed before.

Here’s what you may notice:

• More frequent pre-approvals for procedures and specialist visits.

• Fewer providers accepting specific plans in local networks.

• Lower reimbursement rates, which may lead to longer wait times or reduced access.

These behind-the-scenes changes may not be highlighted in plan advertisements but could affect how easily and quickly you receive care.

New Caps on Drug Spending Are Welcome—but Conditional

One of the most anticipated changes in 2025 is the introduction of a $2,000 annual cap on out-of-pocket prescription drug costs under Medicare Part D. Since most Medicare Advantage plans include drug coverage, this cap applies to many Part C enrollees.

But the impact varies:

• Some plans may require you to remain within a specific pharmacy network to take full advantage of this cap.

• Others may automatically enroll you in the Medicare Prescription Payment Plan, which spreads drug costs monthly instead of all at once—but opting out could be tricky.

You should review your plan details carefully, especially the section outlining prescription drug management, to see if and how the cap will benefit you.

Fewer Supplemental Extras Are Being Offered

Although 2024 saw widespread access to supplemental benefits like transportation, fitness memberships, and over-the-counter allowances, 2025 is different.

• The share of plans offering over-the-counter (OTC) benefits has dropped significantly.

• Transportation assistance is less common.

• In some regions, plans are replacing broad benefit categories with condition-specific extras (e.g., only those with diabetes get meal delivery).

While these supplemental features were never guaranteed, many enrollees had come to rely on them. If your 2025 plan has dropped one you use, it might be worth comparing your options next enrollment period.

Networks Are Becoming More Localized

Provider network limitations are a growing trend in 2025. To control costs and negotiate better terms, some Medicare Advantage plans are narrowing their networks.

This could mean:

• Your preferred doctor or hospital is no longer considered in-network.

• You’ll pay higher out-of-pocket costs for out-of-network care.

• Even within a network, certain specialists may now require referrals that weren’t previously needed.

Before scheduling care, always verify provider participation through your plan’s directory or by calling the office directly.

Star Ratings May Be Misleading

Medicare’s star rating system still plays a major role in how plans are evaluated and presented to the public. But in 2025, more plans have seen their ratings fluctuate due to updated CMS evaluation criteria.

Here’s what’s changed:

• Emphasis has shifted more toward customer experience and less on clinical outcomes.

• Some plans previously rated 4 stars or higher in 2024 have dropped a full point or more.

• Plans with lower star ratings may still offer strong provider networks or useful benefits.

This means that a plan’s rating alone isn’t enough to judge its quality. It’s just one data point you should consider alongside coverage, cost, and your personal healthcare needs.

Premium Increases Aren’t the Only Cost to Watch

Even if your 2025 plan has a modest premium, other costs may have increased:

• Copayments for specialist visits and urgent care may be higher.

• Maximum out-of-pocket (MOOP) limits can now reach up to $9,350 for in-network services.

• Coinsurance for outpatient services may have shifted from fixed copays to percentage-based billing.

These changes could result in higher overall costs even if your monthly premium hasn’t risen substantially.

Benefits for Chronic Conditions Are More Targeted

Special Needs Plans (SNPs) under Part C are evolving in 2025. While their goal remains to support individuals with chronic or complex health needs, the approach is becoming more specialized.

New developments include:

• Benefits tailored to specific diagnoses (e.g., chronic obstructive pulmonary disease or diabetes).

• Limited access to certain supplemental services unless you meet condition-specific criteria.

• Plans increasingly using predictive algorithms to tailor outreach or support services.

If you have a chronic condition, review your plan’s Evidence of Coverage (EOC) to ensure the benefits align with your ongoing needs.

Mid-Year Notifications Will Affect Benefit Use

In 2025, Medicare Advantage enrollees will receive a Mid-Year Enrollee Notification of Unused Supplemental Benefits. This update will inform you of unused plan benefits from the first half of the year.

Why this matters:

• It helps you take full advantage of offerings you may have overlooked.

• You can make more informed healthcare decisions before year-end.

• It’s especially useful for benefits like wellness visits, dental cleanings, or vision exams.

This notice is expected between June 30 and July 31. Don’t ignore it—it could help you make the most of your coverage.

Telehealth Coverage Is Evolving Again

The expansion of telehealth during the public health emergency (PHE) shifted expectations across all Medicare plans. Now that the PHE is no longer in effect, 2025 Medicare Advantage plans are reassessing their offerings.

Here’s what’s happening:

• Some plans are scaling back telehealth services or limiting them to behavioral health only.

• Others are keeping broader virtual access, but may charge higher cost-sharing than in previous years.

• Rural beneficiaries may face fewer telehealth options if broadband access is limited.

If virtual care is important to you, check your plan’s telehealth policy and cost structure before your next appointment.

Enrollment Flexibility Still Exists—But Has Limits

The Annual Enrollment Period (AEP), from October 15 to December 7, remains your main chance to change or switch Part C plans. But there are other opportunities in 2025:

• The Medicare Advantage Open Enrollment Period (January 1–March 31) lets you switch from one Medicare Advantage plan to another or back to Original Medicare.

• Special Enrollment Periods (SEPs) may be granted for qualifying life events such as moving, losing employer coverage, or plan terminations.

However, switching plans mid-year may reset deductibles or disrupt continuity of care. Make sure you understand all implications before making a change.

Watch for ANOC Letters This Fall

Every September, Medicare Advantage plans must send an Annual Notice of Change (ANOC) letter outlining updates to your plan for the next year. These letters are more important than ever in 2025.

You should:

• Review changes to premiums, cost-sharing, and covered benefits.

• Compare those updates to your healthcare needs and budget.

• Use this time to decide whether you want to remain in your plan or explore others during AEP.

Ignoring the ANOC letter could result in surprises come January.

Your Plan in 2025: More Than Just the Premium

What you pay each month is just one piece of the puzzle. In 2025, the most meaningful changes to Medicare Advantage plans may show up in the form of altered coverage, reduced access, or benefit reshuffling.

Use every available tool to evaluate your current plan:

• Read your plan’s Evidence of Coverage and Summary of Benefits.

• Make note of any benefit reductions or increased costs.

• Watch for the Mid-Year Notification and Annual Notice of Change letters.

And if you’re unsure about what changes mean for you, don’t hesitate to speak with a licensed agent listed on this website who can walk you through your options.