What Part D changes may affect my Medicare plan? One of the most notable changes in 2025 is the removal of the coverage gap, also known as the "donut hole." This simplifies the coverage stages to just three, which include: Annual Deductible, Initial Coverage and Catastrophic Coverage.
In CY 2025, the IRA eliminates the coverage gap phase and the related CGDP and, in its place, establishes the new Discount Program. The IRA also alters the defined standard benefit to exempt certain drugs (certain insulins and vaccines) from the deductible.
Fifth consecutive year of cuts: Physicians face a 2.8% cut in Medicare payments in 2025—the fifth consecutive year of reductions—while the cost of running a practice continues to rise.
CMS Launches Five New Models at the End of 2025: Looks to Advance ACCESS, BALANCE, MAHA ELEVATE, GLOBE and GUARD in 2026
More than half of eligible Medicare beneficiaries are enrolled in Medicare Advantage in 2025. In 2025, more than half (54%) of eligible Medicare beneficiaries – 34.1 million out of about 62.8 million Medicare beneficiaries with both Medicare Parts A and B – are enrolled in Medicare Advantage plans.
The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025. The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.
In 2026, the Centers for Medicare and Medicaid Services (CMS) is ending a program called the Value-Based Insurance Design (VBID) model. This program helped health plans give extra non-medical benefits, like credits for healthy food and utilities.
The July 2025 CMS updates introduce new HCPCS codes for drugs and biologics, revised SNF consolidated billing enforcement, and changes to blood clotting factor and prosthetic codes that affect documentation and reimbursement.
Healthcare changes in 2025 are shaped by major federal legislation like the One Big Beautiful Bill Act (OBBBA), introducing significant shifts in Medicaid, Medicare, and ACA marketplaces, alongside ongoing tech advances in AI and personalized medicine, while new Medicare Part D caps on drug costs start for beneficiaries. Expect major impacts in 2026, including potential Medicaid work requirements, ACA marketplace adjustments, and new prescription drug cost rules, alongside evolving trends in data-driven care and industry consolidation.
One of the biggest CMS trends in 2025 is the shift toward visual editing and low-code/no-code integrations, giving both technical and non-technical users the power to move faster. Today's content creators expect intuitive interfaces, think drag-and-drop editors, real-time previews, and modular content blocks.
No, the Medicare eligibility age is not changing to 67. The phase-in of raising the retirement age to 67, which began in 1983, was completed in 2023. This keeps the retirement age static at 67 years for those who turn 62 in 2022 or later. However, the Medicare eligibility age remains at 65 years for most people.
A new report from the Department of Health and Human Services Assistant Secretary for Planning and Evaluation (ASPE) projects that around 11 million people with Medicare Part D will reach the new $2,000 out-of-pocket cap in 2025, with an average savings of $600 for the year.
Starting in 2025, there is an annual limit on what you pay out-of-pocket for prescription medications through Medicare and Medicare Advantage prescription drug plans. All prescription medications, including specialty medications, covered by Part D plans are included under this cap.
Through January 30, 2026, Medicare covers telehealth services that you can get from anywhere in the U.S., including your home. Starting January 31, 2026, you must live in a rural area and go to an office or medical facility that's also in a rural area (in the U.S.) for most telehealth services.
Medicare Advantage Highlights for 2025
However, the share of plans offering certain benefits has declined, such as over-the-counter benefits (85% in 2024 vs. 73% in 2025), remote access technologies (74% in 2024 vs. 53% in 2025), meal benefits (72% in 2024 vs. 65% in 2025) and transportation (36% in 2024 vs.
Big changes are coming to Medicare in 2026, focusing on lowering drug costs with a $2,100 Part D out-of-pocket cap, negotiated lower prices for some drugs (including weight-loss meds), and free adult vaccines, alongside rising Part B premiums and deductibles, a new Part B prior authorization pilot, and increased focus on accuracy in Medicare Advantage plans. These shifts aim to improve affordability and access, but beneficiaries will see increased costs for some services while benefiting from new drug price protections and plan adjustments.
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The 2025 budget reconciliation bill (H.R. 1), signed into law on July 4, 2025, introduces new work requirements, also referred to as community engagement requirements, for certain Medicaid enrollees. The provision makes continued Medicaid eligibility contingent upon participation in work or other qualifying activities.
From 1 July 2025, changes will be made relating to chronic condition management arrangements under the MBS. These changes include: Replacing the existing two plan (GP management plan and team care arrangements) framework with a single planning item for chronic conditions (GP chronic condition management plan);
CMS updates for 2025 focus on enhancing Medicare Advantage/Part D, expanding telehealth, improving hospice care, mandating new compliance for settlements (WCMSA), updating payment rules (Physician Fee Schedule), and adding new codes for services like caregiver training, impacting everything from enrollment to provider reimbursement and quality measurement. Key changes include removing the Part D coverage gap (donut hole), increasing oversight for hospice agencies, and provisional additions to the telehealth list.
CPT codes are used to report medical, surgical, and diagnostic services performed by healthcare professionals. HCPCS codes are used to report medical procedures and services to Medicare, Medicaid, and other health insurance programs.
The COLA was 2.5 percent in 2025. Nearly 71 million Social Security beneficiaries will see a 2.8 percent COLA beginning in January 2026. Increased payments to nearly 7.5 million people receiving SSI will begin on December 31, 2025. (Note: Some people receive both Social Security benefits and SSI).
Medicare premiums and deductibles are increasing for 2026, with the standard Part B monthly premium rising to $202.90 (up $17.90) and the Part B deductible increasing to $283 (up $26), driven by rising healthcare costs, while Part A hospital deductibles also go up to $1,736. These changes, announced by CMS, will mean higher out-of-pocket costs for many beneficiaries, impacting those on fixed incomes, with Part D drug costs also facing caps.
If your plan ends, you'll return to Original Medicare, which covers hospital and medical services. However, you'll lose extras like dental, vision, and prescription benefits. You can enroll in: A new Medicare Advantage plan, or.