The changes coming to Medicare Advantage plans can be a bit confusing, but Healthfirst is here to help you.
Serving New Yorkers for more than 30 years, Healthfirst continues to help our close to two million members navigate the world of healthcare and make it easy for them where we can. Let us help you understand the latest changes to Medicare and how they might affect you.
If you have any questions, please call us at one of the numbers below. Our team of Medicare specialists is here to help.
In the past, those on both Medicare and Medicaid (“Duals”) could switch Medicare Advantage plans every quarter. That will change.
Beginning in 2025, only under certain circumstances will Dual members be able to switch plans:
Dual members can always switch plans during the Annual Enrollment Period (October 15–December 7) and the Open Enrollment Period (January 1–March 31).
It will now be even more important to make sure you enroll in the right Medicare Advantage plan for your needs right from the start, because this will be your plan for a full year.
A Special Election Period lets you choose a new plan that better meets your new needs if you experience a major change in your life, such as if you:
Our specialists can work with you to find the best plan for you. We can also help you find any savings programs that you may qualify for, including Medicaid, Medicare Savings Program, Low Income Subsidy, Extra Help, and more.
Whether you are already a Healthfirst member or shopping for a new plan, call one of our Medicare specialists today and let’s check your eligibility.
There will be a number of changes to Prescription Drug coverage:
You will now have more coverage for your prescription costs than you did before.
If your plan includes prescription drug copays, that won’t change. You’ll still have that cost. (You can check to see if your copays will change during the Annual Enrollment Period.) However, you’ll no longer have to pay out-of-pocket during the “donut hole.” This could save you up to thousands of dollars a year, so it’s great news.
And you may pay less depending on your prescriptions.
If you pay a lot for prescriptions now, your costs will be capped at $2,000, which could save you a lot of money each year.
If you don’t spend much on prescriptions, then this probably won’t impact you. Dual members with Medicare and Medicaid may see some changes, but since dual plans already include prescription savings, there may not be much of a cost impact.
A few plans with prescription drug deductibles may have an increase for certain drugs. Check your plan to see if you will be affected.
As always, it’s a good idea to confirm that your prescriptions are still on the 2025 drug list.
If your prescriptions will no longer be covered, your doctor can often prescribe a substitute that is. You can also view substitutes in our Comprehensive Formulary (drug list).
You can check Comprehensive Formulary (drug list) to see if your prescriptions are covered.
There’s a new option to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January–December). But it’s not right for everyone, so be sure you understand your options before you make a change.
While this new plan doesn’t reduce your prescription drug costs, it does help you manage the payments by spreading them out over months instead of paying in one lump sum.
You will most likely benefit from this new Medicare Prescription Payment Plan if you have high drug costs that start earlier in the calendar year. Although you can participate at any time of the year, starting earlier in the year (for example, before September) gives you more months to spread out your payments. Again, this may not be the right for everyone and depends on your Part D Prescription drugs.
We can help you decide if you should participate, based on your prescribed drugs. Call us and let's talk.
If you would like to learn more about the new Medicare changes, or have questions, give us a call and we can help. We can also see if you are eligible for any savings programs and even help you apply.
October to March, 7 days a week, 8am–8pm;
April to September, Monday to Friday, 9am–8pm
October to March, 7 days a week, 8am–8pm;
April to September, Monday to Friday, 8am–8pm
As part of the Inflation Reduction Act, the Centers for Medicare & Medicaid Services (CMS) instituted changes to Medicare that would make Part D prescription drug costs more affordable, expand benefits, and help keep premiums stable for millions of Americans. These changes go into effect on January 1, 2025.
Many of the changes are outlined at the top of this page and include reducing prescription drug costs, lowering the cap on prescription out-of-pocket costs, eliminating the Medicare Part D coverage gap or “donut hole,” and more.
Yes. Beginning January 1, 2025, all Medicare Advantage plans will need to change per the Inflation Reduction Act and CMS changes.
Yes. If you are on a dual plan (which means you have both Medicare Advantage and Medicaid), you’ll now be limited to how often you can switch. You’ll be able to switch monthly if you’re eligible for an integrated benefits plan, which means your Medicare and Medicaid enrollment is all in one plan. Also, Duals have a monthly switching opportunity if they choose to leave their plan for Original Medicare. Just be sure to understand the benefits you will no longer receive when you switch to Original Medicare.
Yes. You can switch Medicare Advantage plans if you have a major life change, such as if you move out of your plan’s service area, have a change in income, or become eligible for home healthcare. These are called Special Election Periods, and they let you find a new plan that better meets your new needs.
No. The Medicare Part D coverage gap or “donut hole” is going away in 2025, so you will have more coverage for your prescription costs than you did before.
The new CMS changes mean that $2,000 is the most you will pay for your prescriptions in 2025. And you may pay less depending on which prescriptions you take.
Some more-expensive prescriptions in higher tiers may now have higher deductibles. Check your plan to see if you’ll be affected.
It’s a good idea to confirm that your prescriptions are still on the 2025 drug list and that copays haven’t changed. Healthfirst-covered prescriptions can be found in our Comprehensive Formulary (drug list).
This new program is designed to help you manage prescription payments and will be available in 2025 as part of the Inflation Reduction Act Medicare changes. While the plan doesn’t lower the cost of your prescriptions, it does let you spread the payments out over months instead of paying in one lump sum.
Our Medicare specialists are happy to help you understand the changes and what they could mean for you.
Call us and let's talk.