As we move into the second half of 2025, Medicare beneficiaries and providers should be aware of several important updates that took effect in July.
These updates are based on official sources including the Centers for Medicare & Medicaid Services (CMS), Medicare.gov, Noridian, and AARP. They impact everything from prescription drug costs to mental health coverage and billing practices. Here’s a breakdown of what’s new and what it means for you.
Prescription Drug Cost Relief
One of the most significant changes this year is the implementation of a $2,000 annual cap on out-of-pocket costs for Medicare Part D enrollees. This long-awaited reform eliminates the coverage gap known as the “donut hole,” making medications more affordable for millions of seniors. To determine how much of the $2,000 annual cap you have met you can call you Part D plan sponsor using the member services phone number on the back of your insurance card. Additionally, a new Medicare Prescription Payment Plan allows beneficiaries to spread their drug costs over the year in monthly installments, easing the financial burden of high-cost prescriptions. Talk to your health plan to determine if the Medicare Prescription Payment Plan might be helpful for you. Please note: this does not reduce the cost of your prescription medications, but does spread out the cost over the course of the year to help members avoid hefty copays all at once. You can enroll by talking to your pharmacist or calling your Part D plan sponsor.
Expanded Mental and Preventive Health Coverage
Medicare has broadened its mental health services to include: – Safety planning for individuals at risk – Services provided by marriage and family therapists Preventive care has also been enhanced. Cardiovascular risk assessments are now reimbursable during standard evaluation and management visits. These services may incur a cpay. Some dental services, IF related to chronic conditions like end-stage renal disease, are now covered.
Medicare Advantage Plan Updates
If you’re enrolled in a Medicare Advantage (MA) plan, be on the lookout for a mid-year benefit reminder. Plans are required to notify members of any unused supplemental benefits between June 30 and July 31.
However, some MA plans have reduced or eliminated certain extras such as over-the-counter (OTC) allowances, transportation, and meal services. Be sure to review your plan’s current offerings. Plans would not cut these benefits mid year, so if you’ve used them during the 2026 plan year they haven’t gone away.
Stay Informed
These updates reflect Medicare’s ongoing efforts to improve access, affordability, and quality of care. Whether you’re a beneficiary or a healthcare provider, staying informed about these changes can help you make the most of your Medicare benefits.
To Learn More
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Resources
CMS MLN Connects Newsletter – July 3, 2025: https://www.cms.gov/training-education/medicare-learning-network/newsletter/2025-07-03-mlnc
CMS Medicare Advantage/Prescription Drug System July 2025 Payment Info: https://www.cms.gov/files/document/medicareadvantageprescriptiondrugsystemjuly2025paymentinformationg.pdf
CMS July 2025 Addendum A: https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient-pps/quarterly-addenda-updates/july-2025-addendum
Medicare & You 2025 Handbook (Large Print): https://www.medicare.gov/publications/10050-le-medicare-and-you0.pdf?linkit_matcher=1
Noridian Medicare Webinar Announcement – July 8, 2025: https://med.noridianmedicare.com/web/jfb/article-detail/-/view/10534/quarterly-medicare-updates-ab-webinar-07082025
AARP: 7 Medicare Changes on the Horizon for 2025: https://www.aarp.org/medicare/changes-coming-in-2025/
We are not a government agency. We are licensed insurance agents who discuss insurance programs such as Medicare Advantage, Medigap, and Medicare Part D Prescription Drug Coverage. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-Medicare to get information on all of your options.
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