Florida has more people getting their health insurance from the federal government than any other state, other than California. More than one out of every 10 Floridians are on traditional Medicare.
Add in the other 2½ million people who use Medicare Advantage through private insurers and about one out of every five people in Florida relies on some version of Medicare to help pay for their health care.
Higher premiums in 2025
On Nov. 8, the Centers for Medicare & Medicaid Services (CMS) released the 2025 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2025 Medicare Part D income-related monthly adjustment amounts.
Medicare Part B, which covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A; and Medicare Part A, which covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and some home health care services, will both increase their monthly premiums.
Prescription drug caps and payment plans
The most significant change to Medicare in 2025 is the implementation of a $2,000 annual out-of-pocket cap for Part D prescription drugs thanks to provisions in the Inflation Reduction Act.
But it’s important to make sure that the plan you chose covers the medications you’re taking.
“The plans are required to have a certain number of medications for every purpose, with the exception of a few categories of drugs, such as cancer drugs or AIDS drugs,” said Jim Tolbert, a Medicare counselor in Tampa through the “Serving Health Insurance Needs of Elders” (SHINE) program offered by the Florida Department of Elder Affairs.
“They don't have to cover every medication, just a certain number for each purpose, and they try to construct a formulary that will be cost effective and provide good benefits for the enrollees. But they don't have to cover every medication.”
Also new in 2025 is a "Manufacturer Discount Program," replacing the previous Coverage Gap Discount Program, and requirement that all Medicare prescription drug plans offer enrollees the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments instead of all at once at the pharmacy.
“With the first 10 high-cost drugs that we negotiated for the Medicare program on behalf of the millions of people who take these drugs … we are balancing innovation and a fair price for people and the negotiations,” said Dr. Meena Seshamani, director of the Center for Medicare within the Centers for Medicare and Medicaid Services.
“We estimate [that] would save Medicare $6 billion and importantly, save people with Medicare prescription drug coverage $1.5 billion, so enabling people to access these drugs and ensure stability and sustainability of the Medicare program.”
A nationwide dementia model test
This past summer, CMS also launched The Guiding an Improved Dementia Experience (GUIDE) Model, a voluntary nationwide model test that aims to support people with dementia and their unpaid caregivers. The model began on July 1, 2024, and will run for eight years. The list has 31 providers and organizations in Florida providing these benefits.
“It's not about treating a diagnosis code, it's about caring for a person, and we know how vital caregivers are to care for that person, so the GUIDE model, particularly for people with dementia, provides additional supports for caregivers, including respite care training, providing upfront money to healthcare providers so that they can better support caregivers,” Seshamani said.
She said the model is being tested to see if it should be incorporated into the broader Medicare program in the future.
It’s important to note, Seshamani said, that Medicare already pays for health care providers to train family caregivers in things like toileting, helping, helping their loved ones to do routine activities, behavioral management, direct care, and wound care.
Future enrollment periods
The deadline to sign up for Medicare passed this weekend.
But there's a special enrollment period that runs from Jan. 1 through March 31 during which you will be able to switch to a different Advantage Plan, or return to Original Medicare and enroll in a drug plan. But that special enrollment period does not apply to people who are in Original Medicare.
When choosing plans, experts say it’s important to consider out-of-pocket costs in addition to monthly premiums.
This story was compiled off an interview conducted by Tom Hudson for The Florida Roundup.
