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

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Webinar | AEP Add-Ons: Cross-Selling During AEP

Webinar | AEP Add-Ons: Cross-Selling During AEP

AEP Add-Ons: Cross-Selling During AEP

Statistically speaking, client retention increases when you have multiple policies in the same house. AEP provides a great opportunity to layer in policies with your clients to help cover gaps in their current coverage.

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– Tools available to quote and enroll over the phone
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Webinar | AEP Add-Ons: Cross-Selling During AEP

Webinar | After AEP: What’s next?

After AEP: What’s next?

The end of AEP (December 7th) is fast approaching. In order to prepare for what’s next, it’s good to start as soon as possible! There are a record number of SARs (Service Area Reductions) to go along with the Open Enrollment Period that starts in January.

Topics to be discussed:

– How to Prepare
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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

Vice President, Marketing

Contact a Pinnacle Representative if you have any questions.

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

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Webinar | AEP Add-Ons: Cross-Selling During AEP

Webinar | Selling Medicare Supplements During AEP

Selling Medicare Supplements During AEP

Most discussions during AEP are centered around Medicare Advantage or Prescription Drug options, but let’s not forget about Medicare Supplements! In some cases, Medicare Supplements can be a great alternative to those who can pass underwriting or have a special election period available. Topics to be discussed:
– Difference between Medicare Supplements and Medicare Advantage
– Potential enrollment options during AEP
– Marketing Ideas
– How to quote and enroll Medicare Supplements
and more!!

Register now. Space is limited.