Medicare is a cornerstone of healthcare for millions of Americans, and each year, the program goes through changes that can significantly impact coverage and costs. With a new year around the corner, it’s important to understand the Medicare updates in 2025 and what they could mean for you.
Most Medicare Part A beneficiaries don’t pay a monthly premium, but the services covered by Part A — like stays at hospitals, skilled nursing facilities, and hospices — may be subject to a deductible and coinsurance. New in 2025, if a beneficiary stays at a hospital for anywhere from one day to sixty days, they’ll pay a $1,676 deductible, $44 higher than in 2024. If the inpatient stay lasts 61-90 days, there’s a daily coinsurance charge of $419.
Here’s a breakdown of the Medicare Part A coinsurance changes from 2024 to 2025.
| Coinsurance | 2024 | 2025 |
| Inpatient hospital deductible | $1,632 | $1,676 |
| Daily hospital coinsurance (days 61-90) | $408 | $419 |
| Daily hospital coinsurance for lifetime reserve days | $816 | $838 |
| Skilled nursing facility daily coinsurance (days 21-100) | $204 | $209.50 |
Medicare Part B covers essential medical services, including outpatient care, preventive services, and durable medical equipment. The standard monthly premium for Part B is $185, which is an increase of just over $10 from 2024. The Part B annual deductible —which differs from the premium — is $257, up $17 from 2024.
Individuals who reported a modified adjusted gross income (MAGI) of more than $106,000 on their 2023 tax return (or $212,000 for those filing jointly) will pay a higher Part B premium. This additional cost, called the Income-Related Monthly Adjustment Amount (IRMAA), is calculated by the Social Security Administration based on tax returns. If IRMAA applies to you, you’ll get a notification letter that tells you all about the increased premium.
Here’s a breakdown of how IRMAA affects Part B costs.
| Modified adjusted gross income for individual filers | Modified adjusted gross income for joint filers | Total monthly premium amount |
| Less than or equal to $106,000 | Less than or equal to $212,000 | $185.00 |
| Greater than $106,000 and less than or equal to $133,000 | Greater than $212,000 and less than or equal to $266,000 | $259.00 |
| Greater than $133,000 and less than or equal to $167,000 | Greater than $266,000 and less than or equal to $334,000 | $370.00 |
| Greater than $167,000 and less than or equal to $200,000 | Greater than $334,000 and less than or equal to $400,000 | $480.90 |
| Greater than $200,000 and less than $500,000 | Greater than $400,000 and less than $750,000 | $591.90 |
| Greater than or equal to $500,000 | Greater than or equal to $750,000 | $628.90 |
The number of Part D plans available has dropped from 709 in 2024 to 524 in 2025. While there are fewer standalone prescription drug plans, Medicare Advantage plans that include Part D coverage have continued to grow in availability, providing another option for beneficiaries.
The Low-Income Subsidy, also known as the Extra Help program, can assist individuals who face challenges with Part D costs, such as premiums and deductibles. In 2025, Medicare will reduce the number of benchmark Low-Income Subsidy (LIS) plans (plans without premiums) by 5%, resulting in 120 available plans. Beneficiaries will have the option to choose from two to six plan options, depending on their state of residence.
Several other 2025 Medicare updates will affect the cost of Part D plans. These include:
Premium and cost adjustments:
Future Developments:
It’s important to review your formulary annually to stay informed about any changes to covered prescriptions.
Medicare Advantage plans have experienced a surge in popularity due to their expanded benefits and, in some cases, lower premiums compared to Original Medicare. However, as we approach 2025, Medicare Advantage enrollees may encounter a reduction in benefits and the withdrawal of major insurers from specific markets.
For those enrolled in Medicare Advantage plans, these changes might mean reduced benefits, fewer plan options (in rural areas, in particular), and care disruption if providers are affected.
Although detailed information won’t be available until later in the year when the Centers for Medicare & Medicaid Services releases its data, expected reductions include supplemental benefits like:
There are a few factors behind the Medicare Advantage updates in 2025.
If you have a Medicare Advantage plan, be sure to review your Annual Notice of Change to understand any plan updates in 2025. An extra help to beneficiaries in 2025 is the new Mid-Year Enrollee Notification of Unused Supplemental Benefits, which requires Medicare Advantage plans to send a personalized list in June and July of any supplemental benefits that enrollees haven’t used in the first half of the year.
Just like Part B, Medicare Part D is also subject to the Income-Related Monthly Adjustment Amount charge on premiums. This surcharge is calculated by the Social Security Administration using your tax return from two years prior. In 2025, expect adjustments to IRMAA costs for specific Medicare premiums.
Part D premiums are set by individual insurers, but the same IRMAA surcharge exists for those who reported incomes over $106,000 (or $212,000 for joint filers).
| Filing individually | Filing jointly | Married but filing separately | Premium adjustment with IRMAA |
| Less than or equal to $106,000 | Less than or equal to $212,000 | Less than or equal to $106,000 | Your plan premium |
| above $106,000 up to $133,000 | above $212,000 up to $266,000 | Not applicable | $13.70 + your plan premium |
| above $133,000 up to $167,000 | above $266,000 up to $334,000 | Not applicable | $35.30 + your plan premium |
| above $167,000 up to $200,000 | above $334,000 up to $400,000 | Not applicable | $57.00 + your plan premium |
| above $200,000 and less than $500,000 | above $400,000 and less than $750,000 | above $106,000 and less than $394,000 | $78.60 + your plan premium |
| $500,000 or above | $750,000 or above | $394,000 or above | $85.80 + your plan premium |
One of the final major updates to Medicare in 2025 is a significant expansion of the Guiding an Improved Dementia Experience (GUIDE) program. Launched in 2024, the program delivers critical resources to dementia patients and their caregivers, including:
The initiative began on July 1, 2024, with 96 participating academic medical centers, hospitals, and community-based organizations of varying sizes. The program will significantly expand its reach in July 2025 by adding 294 more organizations.
To participate in the GUIDE program, individuals must be enrolled in Original Medicare, have a confirmed dementia diagnosis, and not currently reside in a nursing home or receive hospice care.
Staying ahead of the curve with Medicare updates in 2025 can be challenging. As healthcare evolves, understanding the new rules, coverage changes, and their implications can help you save money and get the care you need. By taking a proactive approach, you can ensure that your current plan works for you.
To ensure your healthcare needs are met, regularly review your plan benefits, any changes, and how those changes might affect you. The Annual Notice of Change that you receive from your plan each year is a valuable resource for staying informed about cost and coverage updates.
Take the time to evaluate your current plan and make sure it still works for you in the upcoming year. Think through any areas of your coverage that you’ve been unhappy with, whether it’s network flexibility, out-of-pocket costs, or supplemental benefits. Then, you can use Medicare.gov or schedule a consultation with a licensed insurance agent to find plans that fit your needs.
You don’t have to sift through your healthcare options and the jargon that comes with them alone. At SmartConnect, our licensed insurance agents can provide you with personalized recommendations and help you compare plan options side-by-side so you can feel confident in your final decision.
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