Medicare changes are coming in 2025. What Stanislaus County seniors need to know
Medicare recipients in Stanislaus County heard about changes to the health program anticipated in 2025 and their coverage options, at an informational forum Friday in Modesto serving to kick off the fall enrollment period.
Seniors on fixed incomes won’t hear about a possible increase in the Medicare Part B monthly premium until November. The Part B premium includes physician services under the Medicare program. Some reports have anticipated a jump from $174.70 a month to $185 in 2025, with the premium deducted from Social Security checks.
In another change, starting Jan 1., Medicare health plans must have a $2,000 cap on out-of-pocket expenses for prescription drugs, eliminating the “doughnut hole” or the temporary limit on drug coverage when a patient’s costs reached a certain amount for a year. This year, the coverage gap was in effect when total drugs costs were between $5,030 and $8,000.
Going forward, out-of-pocket drug costs are capped at $2,000 a year for people with Medicare Part D drug plans or the prescription drug coverage in Medicare Advantage plans, according to Medicare.gov.
The county Health Insurance Counseling and Advocacy Program held the annual forum at the Stanislaus Veterans Center to help people make decisions during the Oct. 15 to Dec. 7 enrollment period.
Medicare is the national health program for adults 65 and older and certain disabled people. Medicare Part A has a $1,632 deductible for hospital stays and Part B covers 80% of costs for physician services, while Part C includes a choice of Medicare Advantage plans providing reduced hospital costs, coverage of deductibles, drug coverage and additional benefits such as dental, vision and hearing.
Medicare participants have prescription drug coverage either through Advantage plans or Part D stand-alone plans.
Representatives of 11 insurers offering Medicare-approved Advantage plans in Stanislaus County served on a panel to talk about their plans’ benefits and to answer questions from the audience. Monthly premiums for these government-subsidized plans range from zero to $131 a month.
The insurance companies hold seminars this time of year for sharing the specific costs and benefits of their plans. More than half the representatives raised their hands when asked if their policies include gym memberships.
Before choosing a health plan, people are advised to consider whether their doctors accept the insurance and their medications are covered, and also the annual limit on out-of-pocket costs. Among the plans in Stanislaus County for 2025, the annual out-of-pocket limit ranges from $297 for Imperial Health Plan to $2,500 for Kaiser Permanente’s Senior Advantage to $5,700 for a Blue Shield plan.
The county HICAP office in Modesto, at 3500 Coffee Road, provides unbiased assistance for people trying to choose a plan, change their coverage or deal with other Medicare issues. Check HICAP’s web page for appointments in Turlock, Ceres, Oakdale and Patterson. Call 209-558-4540.
HICAP will hold two more Medicare forums set for: the Gladys Lemmons Senior Center, 450 East A St., in Oakdale at 1 p.m. Oct. 22; and the Turlock Senior Center, 1191 Cahill Ave., in Turlock at 1 p.m. Oct. 28.
What follows are some details of Medicare-approved Advantage plans in Stanislaus County:
- AARP Medicare Advantage, network including Sutter Health and AllCare; three plans at zero to $97 monthly premium; zero copays for primary care visits, $5 to $15 copays for specialists; zero to $47 copays for prescription drugs; $2,900 to $3,800 annual out-of-pocket limit (except drugs); dental, vision and hearing.
- Alignment Health, network including Doctors Medical Center, Emanuel hospital and AllCare; three plans at zero monthly premiums; no copays for primary care visits, zero to $5 for specialists; zero to $45 copays for prescription drugs; $1,999 to $3,999 annual out-of-pocket limit (except drugs); dental, vision and hearing.
- Blue Shield of California, Doctors, Emanuel, Memorial hospitals, AllCare and Sutter; $38 monthly premium; zero copays for primary care visits, specialists; zero to $40 copays for prescription drugs; $5,700 annual out-of-pocket limit (except drugs); dental, vision and hearing.
- Central Health Medicare Plan, Doctors, Emanuel, Memorial hospitals, Central Valley Medical Group; zero monthly premium; zero copays for primary care visits, $10 for specialists; zero to $35 copays for prescription drugs; $2,499 annual out-of-pocket limit (except drugs); dental, vision and hearing.
- Humana, Doctors, Emanuel, AllCare, Central Valley Medical Group; zero monthly premium; zero copays for primary care, specialists; zero to $40 copays for prescription drugs; $2,900 annual out-of-pocket limit (except drugs); dental, vision and hearing.
- Imperial Health Plan, Memorial, Doctors, Emanuel, Oak Valley, AllCare; zero monthly premium and $60 Part B premium rebate per month; zero copays for primary care and specialists; zero to $45 copay for prescription drugs; $297 annual out-of-pocket limit; dental, vision and hearing.
- Kaiser Senior Advantage, services at Kaiser Permanente facilities; two plans at zero to $65 monthly premium, $5 Part B reduction for basic plan; $5 copays for primary care visits, $10 for specialists; zero to $47 copays for prescription drugs; $2,500 to $4,900 annual out-of-pocket limit (except drugs); optional dental, vision and hearing.
- SCAN Health Plan, Doctors, Emanuel, Memorial, Central Valley Medical Group; zero monthly premium; zero copays for primary care, specialists; zero to $45 copays for prescription drugs; $1,200 annual out-of-pocket limit (except drugs); dental, vision and hearing.
- WellCare by Health Net, Doctors, Memorial, Emanuel, Oak Valley hospitals, Sutter Gould; zero monthly premium; zero copays for primary care, specialists; zero to 25% copays for prescription drugs; $4,150 annual out-of-pocket limit (except drugs); dental, vision and hearing.
- Anthem Prime, Doctors, Memorial, Emanuel hospitals; zero monthly premium; zero to 20% copay for prescription drugs; $1,200 out-of-pocket limit (except drugs); vision.
