Getting a handle on the basics of Medicare can help protect your health — and your nest egg — in retirement, so making the right choices during Medicare open enrollment is arguably one of the most important financial decisions you can make.
Open enrollment runs from Oct. 15 to Dec. 7 each year. You can tell by the advertisements that inundate the airwaves and your mailbox. You’re likely even getting unsolicited calls and emails. All kinds of health insurance brokers and companies want to dazzle you with their offerings.
First, let’s review the basics. As most retirees know, Medicare has several parts. Part A, which is offered at no cost, generally covers hospitalizations. Part B covers outpatient medical care. Part D is prescription drug coverage provided by private insurers. If you want a primer on how Medicare works and will change next year, consider downloading the Medicare & You Handbook for 2025.
Medicare Advantage is the umbrella term for plans offered by private insurers regulated by Medicare to replace parts B and D. Medigap plans, also offered by private companies, are supplemental plans that cover copays and coinsurance charges imposed under Medicare Part B. While some people assume that Medicare will cover all their healthcare costs, experts warn there are things Medicare won't cover.
A 65-year-old retiring in 2024 could expect to spend an average of $165,000 in healthcare and medical expenses throughout retirement, according to data from Fidelity Investments. This highlights the importance of reviewing your Medicare plan choices during open enrollment each year to ensure you have the best coverage to meet your needs.
1. Open enrollment dates
Every year, Medicare’s open enrollment period runs from Oct. 15 to Dec. 7. This is the time to enroll in or make changes to any Medicare or Medicare Advantage policies, although you may be restricted from making a change regarding a supplementary policy, or Medigap.
There is another open enrollment period only for people with Medicare Advantage plans, from Jan. 1 to March 31. During this January open enrollment, you can change from one Medicare Advantage plan to another or go back to original Medicare.
But while authorities urge an annual review of your coverage, you don’t have to do anything if you’re happy with what you have. If you want to maintain your current Medicare coverage, you do not need to re-enroll.
2. Few people take advantage of open enrollment
While Part D plans can change the drugs they cover, and Medicare Advantage plans can change their provider networks as well as your costs and other provisions, fewer than one-third of enrollees are estimated to take advantage of open enrollment to compare plans and reevaluate their coverage.
Tim Smolen, director of the Washington State Health Insurance Assistance Programs (SHIP), which helps residents navigate Medicare, says beneficiaries consistently care about three things during open enrollment: access, what benefits are included in their plan, and cost.
That last issue is the toughest to gauge. “It's very difficult to forecast in the year ahead how much healthcare you're going to use,” he says.
3. Limits on Medigap changes
People who choose to keep traditional Medicare may also enroll in a supplemental Medigap plan from a private insurer to cover costs like copays. Traditional Medicare, when not paired with Medigap, does not have a limit on out-of-pocket expenses in a year.
Medigap policies, which cannot be paired with Medicare Advantage plans, have standardized benefits. Most states offer 10 types of Medigap policies, but premiums vary by insurer. You can compare costs, benefits and availability on Medicare’s website.
If you have a Medicare Advantage plan, you may switch to traditional Medicare, but you may have trouble getting a Medigap policy. Some states offer more protections than others, but, in general, your first time enrolling in Medicare is your best opportunity to get a Medigap policy.
4. Medicare Advantage differences
These plans have a monthly cost, in addition to the Part B premium, that varies depending on the plan. The plans frequently include prescription drug coverage and limits on annual out-of-pocket costs for covered services.
They also may offer extras not included by traditional Medicare, such as dental, hearing and vision coverage and gym memberships. They are able to do this because they manage costs, partly by limiting beneficiaries to in-network providers. During open enrollment, experts recommend checking to make sure your preferred providers remain in the network for your plan.
Three in 10 beneficiaries in Medicare Advantage plans said they did not use any of their plan’s supplemental benefits in the past year, according to a study by The Commonwealth Fund. The study also found evidence that Medicare Advantage plans were more likely to burden patients with the need to obtain prior approvals, so check plan requirements carefully.
Starting in 2025, Medicare Advantage plans will be required to send policyholders a personalized “Mid-Year Enrollee Notification of Unused Supplemental Benefits” in July. It will list all supplemental benefits the person hasn’t used, the scope and out-of-pocket cost for claiming each one, instructions on how to access the benefits and a customer service number to call for more information.
5. Medicare Advantage issues
These plans have been criticized in recent years for their aggressive marketing tactics. Some beneficiaries have reported having good experiences with their Advantage plans until they get sick and find themselves fighting for coverage.
In 2023 and 2024, the government agency managing Medicare issued new rules to protect seniors against these aggressive marketing practices. These rules prohibit ads that omit the plan name or use Medicare logos to imply that their messaging is from the government.
In 2025, the Centers for Medicare & Medicaid Services (CMS) hopes to end sales incentives for Medicare Advantage and Part D plans. Salespeople sometimes get incentives, such as hefty bonuses, when they enroll Medicare beneficiaries into private insurers’ Medicare Advantage plans, Medigap or Part D prescription drug plans. The coming rule change is meant to disincentivize steering people to insurance plans to earn perks and not serve the best interests of Medicare beneficiaries.
6. Medicare premiums
Beneficiaries of traditional Medicare pay a standard monthly rate of $174.70 for Medicare Part B in 2024, an increase of $9.80 from $164.90 in 2023. The annual deductible for all Medicare Part B beneficiaries is $240 in 2024, an increase of $14 from the annual deductible of $226 in 2023. This rate applies to individuals with incomes less than $103,000, with income-related monthly adjustments applying at various levels to people who make more.
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital is $1,632 in 2024, an increase of $32 from $1,600 in 2023. Beneficiaries are required to pay a coinsurance amount of $408 per day for the 61st through 90th day of a hospitalization in a benefit period, compared to $400 a day in 2023, and $816 per day for lifetime reserve days, up from $800 a day in 2023.
For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period is $204 in 2024; this was $200 in 2023.
Average premiums, benefits and plan choices for Medicare Advantage and the Medicare Part D prescription drug program remained stable in 2024, according to the Center for Medicare and Medicaid Services.
The average monthly plan premium for Medicare Advantage plans, which includes Medicare Advantage-prescription drug plans, is $18.50 in 2024, which is an increase of $0.64 from last year. Most enrollees who kept their plans experienced little or no premium increase for 2024, with nearly 75% of beneficiaries not seeing any premium increase.
In 2024, the out-of-pocket limit for Medicare Advantage plans may not exceed $8,850 for in-network services and $13,300 for in-network and out-of-network services combined. These out-of-pocket limits apply to Part A and B services only, and do not apply to Part D spending.
Medicare premiums for 2025 haven't been announced yet, but they are typically announced shortly before open enrollment begins. However, there is some information we know about Part D: In 2025, Medicare beneficiaries will pay no more than $2,000 out of pocket for prescription drugs covered under Part D. Part D enrollees will also have the option of spreading out their out-of-pocket costs over the year rather than face high out-of-pocket costs in any given month. This new rule applies only to medications covered by your Part D plan and does not apply to out-of-pocket spending on Medicare Part B drugs.
7. Watch out for IRMAA
People with higher income are charged higher Part B and D premiums — the income-related monthly adjustment amount, or IRMAA. In 2023, a single person with an income between $97,000 and $123,000 was charged $230.80 a month for Part B, compared to premiums of $164.90 for people who earned less. In 2024, people who make between $103,000 and $129,000 pay an extra $69.90 a month, for a total of $244.60.
Your income for IRMAA purposes is calculated based on income two years before the plan year.
Medicare will determine the 2025 IRMAA charge in the fourth quarter of 2024. That is why your IRMAA determination is based on 2023 filing status and income — it's the last data point Medicare can obtain from the IRS to determine the 2025 IRMAA charge. Read Medicare Premiums 2025: Projected IRMAA for Parts B and D and compare your 2023 MAGI to get an idea of what IRMMA your charges could be in 2025.
8. Avoiding the surcharge
You can appeal your IRMAA if your income is significantly lower now than two years ago due to a life-changing event, such as retirement, divorce or death of a spouse, or if you think the government made a mistake. Beyond that, the only way to avoid the surcharge is to have less modified adjusted gross income (MAGI), which includes all taxable income from work and investments, as well as the taxable portion of your Social Security.
Unfortunately, most popular deductions, such as charitable donations and mortgage interest, do not reduce your MAGI. However, withdrawals from Roth IRAs don’t count toward your MAGI. If you’re still working, you can contribute more toward tax-deferred retirement accounts to lower your income. Another option is to delay starting Social Security.
9. When do you have to enroll in Medicare?
In general, you initially enroll in Medicare within three months before and three months after turning 65. Failing to do so can result in financial penalties, increasing your premiums for the rest of your life.
However, there are exceptions, including many people who receive health insurance through their employer or through their spouse’s job, as long as the workplace has 20 or more employees. Be sure to check with your employer about how it handles your group health coverage at age 65.
Read Medicare Upgrades Could Disqualify Your Private Plan to understand how upgrades coming to Medicare in prescription drug coverage under the Inflation Reduction Act may actually cause problems for some people who delay enrolling in Medicare.
Be warned of the “COBRA trap” — insurance you may receive after you leave your job does not eliminate the requirement that you apply for Medicare at age 65.
If you miss the Medicare annual open enrollment deadline, there are still some ways you can salvage your status.
10. Help is available
The choices can seem overwhelming, and the marketing can be confusing and misleading. Fortunately, each state has unbiased experts who can walk you through the different plans and help you make sure your plans are the best for your needs.
State Health Insurance Assistance Programs can be found through www.shiphelp.org or by calling 877-839-2675. You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227) 24 hours a day during open enrollment, including weekends, for assistance.
Note: This item first appeared in Kiplinger Retirement Report, our popular monthly periodical that covers key concerns of affluent older Americans who are retired or preparing for retirement. Subscribe for retirement advice that’s right on the money.
