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2025 Medicare Parts A & B Premiums and Deductibles

2025 Medicare Parts A & B Premiums and Deductibles

2025 Medicare Parts A & B Premiums and Deductibles
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On November 8, 2024, 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 Premium and Deductible

Medicare Part B 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.

Each year, the Medicare Part B premium, deductible, and coinsurance rates are determined according to provisions of the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $185.00 for 2025, an increase of $10.30 from $174.70 in 2024. The annual deductible for all Medicare Part B beneficiaries will be $257 in 2025, an increase of $17 from the annual deductible of $240 in 2024. 

The increase in the 2025 Part B standard premium and deductible is mainly due to projected price changes and assumed utilization increases that are consistent with historical experience.

Beginning in 2023, individuals whose full Medicare coverage ended 36 months after a kidney transplant, and who do not have certain other types of insurance coverage, can elect to continue Part B coverage of immunosuppressive drugs by paying a premium. For 2025, the standard immunosuppressive drug premium is $110.40.

Medicare Part B Income-Related Monthly Adjustment Amounts

Since 2007, a beneficiary’s Part B monthly premium has been based on his or her income. These income-related monthly adjustment amounts affect roughly 8% of people with Medicare Part B. The 2025 Part B total premiums for high-income beneficiaries with full Part B coverage are shown in the following table:

The 2025 Part B total premiums for high-income beneficiaries who only have immunosuppressive drug coverage are shown in the following table:

Part B Immunosuppressive Drug Coverage Only
Beneficiaries who file individual tax returns with modified adjusted gross income: Beneficiaries who file joint tax returns with modified adjusted gross income: Income-Related Monthly Adjustment Amount Total Monthly Premium Amount
Less than or equal to $106,000 Less than or equal to $212,000 $0.00 $110.40
Greater than $106,000 and less than or equal to $133,000 Greater than $212,000 and less than or equal to $266,000 $73.60 $184.00
Greater than $133,000 and less than or equal to $167,000 Greater than $266,000 and less than or equal to $334,000 $184.10 $294.50
Greater than $167,000 and less than or equal to $200,000 Greater than $334,000 and less than or equal to $400,000 $294.50 $404.90
Greater than $200,000 and less than $500,000 Greater than $400,000 and less than $750,000 $404.90 $515.30
Greater than or equal to $500,000 Greater than or equal to $750,000 $441.70 $552.10

Premiums for high-income beneficiaries with full Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows: 

Full Part B Coverage
Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses with modified adjusted gross income: Income-Related Monthly Adjustment Amount Total Monthly Premium Amount
Less than or equal to $106,000 $0.00 $185.00
Greater than $106,000 and less than $394,000 $406.90 $591.90
Greater than or equal to $394,000 $443.90 $628.90

Premiums for high-income beneficiaries with immunosuppressive drug only Part B coverage who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:

Part B Immunosuppressive Drug Coverage Only
Beneficiaries who are married and lived with their spouses at any time during the year, but who file separate tax returns from their spouses with modified adjusted gross income: Income-Related Monthly Adjustment Amount Total Monthly Premium Amount
Less than or equal to $106,000 $0.00 $110.40
Greater than $106,000 and less than $394,000 $404.90 $515.30
Greater than or equal to $394,000 $441.70 $552.10

Medicare Part A Premium and Deductible

Medicare Part A covers inpatient hospitals, skilled nursing facilities, hospice, inpatient rehabilitation, and some home health care services. About 99% of Medicare beneficiaries do not have a Part A premium since they have at least 40 quarters of Medicare-covered employment, as determined by the Social Security Administration. 

The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,676 in 2025, an increase of $44 from $1,632 in 2024. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2025, beneficiaries must pay a coinsurance amount of $419 per day for the 61st through 90th day of a hospitalization ($408 in 2024) in a benefit period and $838 per day for lifetime reserve days ($816 in 2024). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $209.50 in 2025 ($204.00 in 2024). 

Part A Deductible and Coinsurance Amounts for Calendar Years 2024 and 2025
by Type of Cost Sharing
2024 2025
Inpatient hospital deductible $1,632 $1,676
Daily hospital coinsurance for 61st-90th day $408 $419
Daily hospital coinsurance for lifetime reserve days $816 $828
Skilled nursing facility daily coinsurance (days 21-100) $204.00 $209.50

Enrollees age 65 and older who have fewer than 40 quarters of coverage, and certain persons with disabilities, pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage, or were married to someone with at least 30 quarters of coverage, may buy into Part A at a reduced monthly premium rate, which will be $285 in 2025, a $7 increase from 2024. Certain uninsured aged individuals who have fewer than 30 quarters of coverage, and certain individuals with disabilities who have exhausted other entitlements, will pay the full premium, which will be $518 a month in 2025, a $13 increase from 2024. 

For more information on the 2025 Medicare Parts A and B premiums and deductibles (CMS-8086-N, CMS-8087-N, CMS-8088-N), please visit https://www.federalregister.gov/public-inspection

Medicare Part D Income-Related Monthly Adjustment Amounts

Since 2011, a beneficiary’s Part D monthly premium has been based on his or her income. Approximately 8% of people with Medicare Part D pay these income-related monthly adjustment amounts. These individuals will pay the income-related monthly adjustment amount in addition to their Part D premium. Part D premiums vary by plan and, regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security benefit checks or paid directly to Medicare. Roughly two-thirds of beneficiaries pay premiums directly to the plan while the remainder have their premiums deducted from their Social Security benefit checks. The 2025 Part D income-related monthly adjustment amounts for high-income beneficiaries are shown in the following table:

Beneficiaries who file individual tax returns with modified adjusted gross income: Beneficiaries who file joint tax returns with modified adjusted gross income: Income-related monthly adjustment amount
Less than or equal to $106,000 Less than or equal to $212,000 $0.00
Greater than $106,000 and less than or equal to $133,000 Greater than $212,000 and less than or equal to $266,000 $13.70
Greater than $133,000 and less than or equal to $167,000 Greater than $266,000 and less than or equal to $334,000 $35.30
Greater than $167,000 and less than or equal to $200,000 Greater than $334,000 and less than or equal to $400,000 $57.00
Greater than $200,000 and less than $500,000 Greater than $400,000 and less than $750,000 $78.60
Greater than or equal to $500,000 Greater than or equal to $750,000 $85.80

Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows: 

Beneficiaries who are married and lived with their spouses at any time during the year, but file separate tax returns from their spouses with modified adjusted gross income: Income-related monthly adjustment amount
Less than or equal to $106,000 $0.00
Greater than $106,000 and less than $394,000 $78.60
Greater than or equal to $394,000 $85.80
For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

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Navigating 2025 Medicare Product Changes: What You Need to Know

Navigating 2025 Medicare Product Changes: What You Need to Know

Navigating 2025 Medicare Product Changes: What You Need to Know
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Recently, we have seen unprecedented changes to live Medicare Advantage plans during Medicare AEP.  Several carriers have made the decision to suppress plans from electronic enrollment systems and/or make certain Medicare Advantage plans non-commissionable to agents.  The thinking is that these are plans that the carriers would like to slow down or stop new sales as much as possible.

Suppressed Plans and Non-Commissionable Plans

  • Certain plans from carriers are becoming non-commissionable or suppressed in electronic platforms.  The Pinnacle team has compiled a list of these plans that are available to agents.
  • Some plans that are now being made non-commissionable in specific areas remain commissionable through paper enrollment in other areas.
  • Suppression means such plans will not appear in platform searches such as Connecture and Sunfire.  The electronic enrollment suppression also extends to the carrier enrollment platforms.

Examples of Changes

  • Cigna has non-commissionable in certain states, while in other states, they remain commissionable with paper applications.
  • Aetna has made plans non-commissionable in several states and suppressed from electronic enrollment.
  • Anthem has changes leading to suppression and non-commission status. 
  • UHC has suppressed several plans in specific states.
  • WellCare plans are suppressed but remain commissionable through paper enrollments.

Paper Enrollment Options

  • Use Pinnacle’s Enrollment Services: We have a dedicated team to process paper enrollments quickly and efficiently.
  • Direct Carrier Fax: You can send paper enrollments directly to carriers using their new business fax numbers listed in Pinnacle’s services.

Understanding Platform Usage

  • Platforms like Connecture and Sunfire still may allow searches for plans that are now suppressed, but you can no longer enroll through the platform.  Otherwise, you would need to use Medicare.gov to run a product comparison.
  • For plans you can’t enroll online, it would be necessary to use paper to submit plans.

The Business Decision Behind Suppression

The driving force behind these changes is a strategic decision by carriers to control enrollment volumes into specific plans, which controls their costs. Changes in the way that CMS is applying Star Ratings as well as changes to the PDP’s implemented through the Inflation Reduction Act are all factors.

Serving as an Agent and Supporting Your Clients

We recommend:

  • Reviewing plan changes specific to your sales region.
  • Accessing the necessary documentation and understanding alternate plan options.
  • Continuously supporting your clients by offering them the most appropriate plans

Conclusion

The 2025 Medicare plan adjustments impose a learning curve for us all, but by staying informed and adaptable, we can continue to provide exceptional service to Medicare beneficiaries. If you have any questions or need more guidance, Pinnacle Financial is here to help every step of the way.

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Bob Brzyski

Bob Brzyski

Vice President, Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

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Understanding CMS & FCC One-to-One Consent Regulations: What Agents Need to Know

Understanding CMS & FCC One-to-One Consent Regulations: What Agents Need to Know

Understanding CMS & FCC One-to-One Consent Regulations: What Agents Need to Know
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If you’re in the business of working with consumer leads, there are new rules you need to be aware of. CMS’s new one-to-one consent regulations and the FCC’s one-to-one consent rules. Both regulations are rolling out, and they will impact how agents and TPMOs (Third-Party Marketing Organizations) can contact consumers. Here’s what you need to know.

CMS One-to-One Consent Regulations (CMS-4205-F)

Starting Date: October 1, 2024

What is it? The CMS (Centers for Medicare & Medicaid Services) is implementing a new rule requiring TPMOs to obtain consumers’ express written consent before sharing their information with another TPMO.

Why should this matter to me as an agent?

After October 1, 2024, if you want to make outbound calls, you’ll need to have a lead that includes a CMS-compliant One-to-One consent.

For inbound warm transfers, it’s a bit different. The lead company needs to have written consent from the consumer, but they can get a one-time real-time verbal consent to transfer the call to another TPMO. The key is that this verbal consent must be recorded and must clearly state the TPMO’s name. It cannot be a generic, “We’re transferring you to an available agent.”

Can I share information with another TPMO?

No. The CMS rule explicitly restricts sharing consumer information with affiliates or other entities unless you have prior written consent from the consumer.

Does this affect inbound calls?

Nope! Direct inbound calls aren’t affected by this regulation.

FCC One-to-One Consent Regulations

Starting Date: January 27, 2025

What is it? The FCC (Federal Communications Commission) has its own set of One-to-One consent rules aimed at controlling forms of automated technology.

What are the key points?

It applies to calls or texts using regulated technology, such as auto dialers, pre-recorded/artificial voice calls, AI voice, or any form of outbound IVR (Interactive Voice Response).

Consent is needed before any such technology can be used to contact a consumer.

The consent must be specific to the purpose. For example, if someone is signing up for Medicare-related info, you cannot slip in consent for calls about auto insurance.

When does it take effect?

Starting January 27, 2025, you cannot make outbound calls or texts using automated technology without having FCC-compliant One-to-One consent.

What Does This Mean for You?

For Agents Handling Leads:

You need FCC-compliant consent starting January 27, 2025, to use any automated technology.

If you work with Medicare-related leads, you’ll also need CMS-compliant consent starting October 1, 2024, if you share data between TPMOs.

Warm transfers? Make sure the lead company has written consent. If you’re transferring a Medicare-related call, get verbal consent on a recorded line, mentioning the specific TPMO.

Final Thoughts

While these regulations might seem daunting, they’re all about protecting consumer privacy. As an agent, understanding and complying with these rules ensures you stay on the right side of the regulations and that you don’t lose valuable leads in the process.

Do you have any questions about how these new regulations might affect your business? Contact a Pinnacle team member today.

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Bob Brzyski

Bob Brzyski

Vice President | Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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DOL Fiduciary Rule Halted by Texas Court: Implications for Financial Professionals

DOL Fiduciary Rule Halted by Texas Court: Implications for Financial Professionals

DOL Fiduciary Rule Halted by Texas Court: Implications for Financial Professionals
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On July 26, 2024, the U.S. District Court for the Eastern District of Texas issued a preliminary injunction to halt the implementation of the Department of Labor’s (DOL) new fiduciary rule, which was set to take effect on September 23, 2024. This decision came in response to a lawsuit filed by the Federation of Americans for Consumer Choice (FACC) and several independent insurance agents, who argued that the rule would cause significant harm if implemented while their case was still pending​.

The Ruling

Judge Jeremy D. Kernodle granted the preliminary injunction, citing concerns that the new fiduciary rule suffered from similar issues as the DOL’s 2016 rule, which was ultimately vacated. The plaintiffs contended that the rule conflicts with the Employee Retirement Income Security Act (ERISA) by redefining the term “fiduciary” to include relationships that do not traditionally involve trust and confidence​​.

The court agreed with the plaintiffs, highlighting that the rule imposes substantial compliance burdens and potential liability under ERISA on insurance agents who deal with ERISA plan members and IRA owners. The injunction will remain in effect until further court orders​.

Background of the Fiduciary Rule

The fiduciary rule, officially known as the Retirement Security Rule, was finalized by the DOL in April 2024. Its primary aim was to extend fiduciary standards of care to most transactions involving annuities, thereby ensuring that financial professionals act in the best interests of their clients when providing retirement investment advice​. The rule sought to close loopholes that allowed some advisors to avoid fiduciary responsibilities, which proponents argued would protect consumers from conflicts of interest. 

Impact on Financial Professionals

The halt of the fiduciary rule’s implementation has significant implications for financial professionals, particularly those involved in retirement planning and annuities:

The halt of the Department of Labor’s fiduciary rule by the Texas court brings several benefits to financial advisors, primarily through reduced regulatory burdens and increased operational flexibility. Here are the positive impacts:

  1. Operational Flexibility: With the fiduciary rule on hold, financial advisors and firms have more freedom in structuring their business models and compensation structures. This flexibility allows advisors to tailor their services to better meet the diverse needs of their clients without being constrained by stringent regulatory requirements​​.
  2. Reduced Compliance Costs: Compliance with the fiduciary rule would have imposed significant costs on advisors, including the need for extensive documentation and potential restructuring of advisory practices. The suspension of the rule alleviates these financial burdens, allowing advisors to allocate resources more efficiently toward client service and business growth​​.
  3. Enhanced Client Relationships: Advisors can maintain their existing compensation models, such as commission-based structures, which can be beneficial for clients who prefer this approach. This continuity helps preserve established advisor-client relationships and prevents disruptions that could arise from a sudden shift to a fiduciary model​​.
  4. Innovation and Growth Opportunities: With fewer regulatory constraints, financial advisors have greater leeway to innovate and develop new products and services. This can lead to more creative solutions for retirement planning and investment advice, ultimately benefiting clients by providing them with a wider range of options tailored to their individual needs​​.
  5. Focus on Client-Centric Practices: While the fiduciary rule aimed to protect consumers, many advisors already adhere to high ethical standards and prioritize their clients’ interests. The suspension of the rule allows these advisors to continue their client-centric practices without additional regulatory pressures, reinforcing their commitment to ethical advisory services​​.
  6. Market Competitiveness: The halt of the fiduciary rule can enhance market competitiveness by allowing smaller advisory firms to compete more effectively. Larger firms with extensive compliance departments would have had an advantage under the fiduciary rule, but with the rule on hold, smaller firms can focus on delivering personalized and high-quality services without being disproportionately burdened by regulatory compliance​​.

Outlook

The Texas court’s decision to halt the DOL’s fiduciary rule offers financial advisors a reprieve from stringent regulatory requirements, allowing for greater flexibility, reduced costs, and enhanced client relationships. Advisors can continue to innovate and grow their businesses while maintaining a strong focus on client-centric practices. As the legal landscape evolves, advisors should remain vigilant and adaptable, ensuring they are well-positioned to navigate future regulatory changes while continuing to serve their clients effectively.

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Bob Brzyski

Bob Brzyski

Vice President - Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

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Contact a Pinnacle Financial Service representative today for assistance.

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2025 Medicare Advantage Commissions- Take Two

2025 Medicare Advantage Commissions- Take Two

2025 Medicare Advantage Commissions- Take Two
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Update to the 2025 FMV.  Commissions are reverting to the typical yearly adjustment.

A recent court decision in Texas has put a pause on certain updates in the 2025 CMS Final Rule that affect Medicare Advantage (MA) and Part D commissions. This directly impacts how agents and brokers get paid. The decision came after trade associations filed lawsuits claiming that these changes were outside of CMS’s legal powers and weren’t properly introduced. So, for now, those changes are on hold. Stay tuned for more updates as this develops!

 For Part D, for example, we’re looking at an increase from $100 to $109 per member per year for initial enrollments, and renewals are going up from $50 to $55. As for Medicare Advantage, the commission bumps will vary depending on the state but expect to see a slight increase pretty much everywhere. See the chart below for the details.

For more information, contact a Pinnacle Financial Services representative today 1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Bob Brzyski

Bob Brzyski

Vice President - Marketing

x7742 | bbrzyski@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881 support@pfsinsurance.com

Contact Us

Contact a Pinnacle Financial Service representative today for assistance.

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