Welcome to Low Income Relief! If you’re feeling overwhelmed by the complexities of Medicare, you’re not alone. Changes for 2025 are just around the corner, and we’re here to break them down in a way that’s easy to understand.
This article covers updates on costs, coverage, and practical tips to help you navigate these changes.
Medicare Costs are Rising in 2025
Unfortunately, Medicare costs will increase in 2025 unless you qualify for specific low income assistance programs. Here’s what you need to know about the new cost structure announced by the Centers for Medicare & Medicaid Services (CMS):
- Medicare Part A (Hospital Care):
- The deductible is increasing from $1,632 to $1,676 for the first 60 days of a hospital stay.
- After 60 days, the daily cost rises to $419 (from $408) through Day 90.
- Medicare coverage stops entirely after 90 days.
- Medicare Part B (Outpatient Care):
- Monthly premiums will increase from $174.70 to $185.
- The deductible rises from $240 to $257.
Medicare will send updated information about your 2025 costs in December. Be sure to check your mail for these crucial updates.
If rising costs are a concern, you might qualify for programs to help reduce your out-of-pocket expenses. Keep reading for details on the Qualified Medicare Beneficiary (QMB) program, which can cover most of your costs.
Changes to Medicare Payments for Providers
While beneficiaries are paying more, doctors will receive 2.93% less in reimbursements from Medicare. This reduction could have ripple effects, such as:
- Difficulty finding doctors who accept new Medicare patients.
- Shorter appointment times as providers manage tighter budgets.
These changes stem from Congress’s failure to approve rate increases and the expiration of a temporary funding boost.
Telehealth Restrictions
Telehealth has been a lifeline for many, but Medicare is rolling back some of the flexibility introduced during the pandemic:
- You may face restrictions on where and how telehealth can be accessed.
- Some services may require in-person visits.
However, certain telehealth services—like caregiving support and counseling—will remain available. Additionally, some phone-based appointments will still be covered even if video access isn’t possible.
Expanded Coverage for Specific Needs
Not all changes are negative. Medicare is expanding access in some areas:
- Digital Mental Health Devices: CMS will now cover FDA-cleared devices for mental health.
- Dental Care for Medical Conditions: While routine dental care isn’t covered, Medicare will pay for dental services necessary for treating other medical conditions. For example, patients undergoing dialysis may receive coverage for dental care to prevent complications.
How the QMB Program Can Help
For those struggling with Medicare’s rising costs, the Qualified Medicare Beneficiary (QMB) program can make a huge difference. This program eliminates most out-of-pocket expenses, including your Medicare Part A and Part B deductibles, coinsurance and copays for Medicare-covered services.
To qualify, you must:
- Be enrolled in Medicare Part A.
- Meet income limits of $1,275 per month for singles or $1,724 per month for couples (higher in Alaska and Hawaii).
QMB is part of Medicaid, but you don’t need full Medicaid coverage to qualify. To apply, simply follow these steps:
- Contact your state’s Medicaid office.
- Submit proof of income and assets as required.
- Notify your medical providers once enrolled to ensure you’re not billed for costs covered by QMB.
Important Note: Federal law prohibits providers from billing QMB participants for Medicare cost-sharing. If you’re improperly billed, report the issue to Medicare or the Consumer Financial Protection Bureau (CFPB).
Relief Recap
While some of these changes are challenging, programs like QMB offer a safety net for eligible low income beneficiaries. Stay informed, protect yourself from scams, and explore all available resources to make the most of your Medicare coverage.
For more ways to save money and get assistance, check out our other resources on Low Income Relief. Together, we can navigate these changes and find solutions that work for you.