Understanding the Latest in Medicare for 2025

Medicare is a government-run health insurance program for people age 65 or older. As a federal program, Medicare standards, coverage, and costs are set at the federal level, and those standards are the same no matter what state the person lives in.

What Are the Ins and Outs of Medicare?

The basic services covered by Medicare are standardized nationally. Because there are gaps in coverage with Original Medicare (Parts A and B), Medicare Advantage Plans (Part C) exist and are run by private companies that must follow strict government mandates. These plans may provide more extensive or effective coverage to meet an individual’s needs. The cost and coverage of these plans will likely determine a person’s choice.

Since changes to Medicare offerings happen every year, there is an annual open enrollment period during which people can sign up for coverage for the first time or change their existing coverage by switching from Original Medicare to Medicare Advantage or vice versa.

In addition to Medicare, a senior may have a private plan through their employer or independently through the health insurance marketplace.

Medicare Parts A and B do not pay for ongoing assistance with the activities of daily living (called “custodial care” in the exclusions of Medicare plans). Medicare Advantage (Part C) may cover some services in the home (referred to as “in-home support”). To understand the benefits of Medicare, visit medicare.gov.

All this makes for a daunting menu of choices and options to find the coverage that best meets one’s needs and circumstances. Fortunately, resources are available to help wade through the information and guide decision-making.

Can a Person Get Both Medicare and Medicaid?

Medicaid covers medical costs for people with limited income and resources. It is a joint federal and state program, and eligibility requirements and benefits vary from state to state.

Just to make things more interesting, some people may qualify to be dually eligible to receive both Medicare and Medicaid. For dually eligible recipients, Medicare pays first when accessing Medicare-covered services. Medicaid pays last after Medicare and any other health insurance kicks in.

Special Medicare Advantage Plans for dually eligible people make getting the services they need easier, including Medicare drug coverage (Part D), and the plans may also cost less. These Special Needs Medicare-Medicaid Plans are only available in certain states. There may also be Program of All-Inclusive Care for the Elderly (PACE) plans that can help certain people get care outside of a nursing home.

What Is New With Medicare in 2025?

Medicare is updated annually to improve access to health care, lower costs, and keep the program accurate. Older adults should be aware of these 2025 changes to Medicare:

• Part D plans must cap out-of-pocket spending on covered drugs at $2,000 a year. This applies to stand-alone Medicare Part D policies and drug coverage in Medicare Advantage Plans. The cap includes deductibles, copayments, and coinsurance for covered drugs. It doesn’t apply to premiums or to drugs a plan doesn’t cover. It doesn’t apply to Part B drugs.
• In 2025, Part D plans can have a deductible of up to $590. Then, copayments are made for medications until the total out-of-pocket cost reaches $2,000.
• The Part D “doughnut hole” or coverage gap has been eliminated.
• Part B premiums for 2025—the part of Medicare that covers doctors’ services and care outside a hospital—are increasing nearly 6% to $185 for most beneficiaries.
• Medicare is prohibited from covering drugs specifically prescribed for weight loss, but Part D plans can cover popular weight-loss drugs when ordered for other purposes, such as Ozempic and Mounjaro for Type 2 diabetes.
• The Food and Drug Administration (FDA) approved Wegovy for people with cardiovascular disease who are overweight. Most Part D plans did not add the drug to their approved lists for 2025 but should for 2026. Other weight-loss drugs may be covered in 2025 since Part D plans can expand coverage as the FDA approves other uses for weight-loss drugs.
• A voluntary nationwide testing program for dementia patients and their caregivers that launched in 2024, Guiding an Improved Dementia Experience (GUIDE), has expanded in 2025. It provides a 24/7 support line, a care navigator to find medical services and community-based assistance, caregiver training, and up to $2,500 a year for at-home, overnight, or adult daycare respite services. Patients and their caregivers typically won’t have copayments. Participants must be enrolled in Original Medicare and have a dementia diagnosis. They can’t be in hospice or a nursing home. To find out more about this, visit the Centers for Medicare & Medicaid Services website.
• Licensed marriage and family therapists, mental health counselors, and addiction counselors can now enroll as Medicare providers, which means your behavioral health care may be covered by the program.
• Medicare Advantage Plans must meet stricter standards to improve access to behavioral health specialists.
• Even though many covered telehealth services that came online during the COVID-19 pandemic have expired, Medicare permanently expanded access to telemedicine for behavioral health services, which can help with access to providers in health care deserts.

Family caregivers may prove helpful to seniors who have trouble reading, accessing, or processing Medicare information. A trusted loved one can serve as an advocate and guide to research Medicare plans to find the best deal and fit.

Visit medicare.gov for up-to-date information on the federal program. In addition, here are some recommendations:

• Your State Health Insurance Assistance Program (SHIP) can provide guidance.
• Review and compare the latest changes to Medicare plans to make sure what you need is covered at a manageable price.
• Be especially sure to check that your primary care physician is still covered by the plan you are enrolled in. If not, you can always change plans as necessary.
• Review Medicare Advantage midyear coverage notices to see what available benefits you haven’t used, such as dental, vision, hearing, or fitness.

How Right at Home Can Help

Right at Home offers a wide range of services to help seniors remain independent. This includes companionship, homemaking, and personal care services such as assistance with hygiene and toileting. While most Medicare plans do not cover nonskilled in-home care, many long-term care insurance policies do depending on the policy and the plan of care. In addition, some veterans programs may pay for in-home care through the U.S. Department of Veterans Affairs (VA). For information on these VA programs and other possible funding sources, download Right at Home’s FREE Ways To Pay Guide today. Use our office locator to speak with the office nearest you for more information.