Medicare Open Enrollment is Ongoing - Are Your Employees Ready?

Medicare beneficiaries are often overwhelmed by their coverage options. Do they select Original Medicare or take a Medicare Advantage or Supplemental plan? Should they elect Medicare Prescription Drug coverage? While both Original Medicare and Medicare Advantage plans provide coverage for services under Parts A and B, they differ significantly in cost structures, provider access, and additional benefits.

Original Medicare offers broad access to healthcare providers nationwide, allowing beneficiaries to see any provider accepting Medicare without referrals. Prior authorization is rare, and beneficiaries can independently choose a stand-alone Part D plan for prescription drug coverage. This flexibility suits individuals seeking unrestricted provider access, though supplemental Medigap policies may be necessary to cover out-of-pocket expenses.

Medicare Advantage and Supplemental plans, by contrast, often include additional benefits like dental, vision, hearing, and fitness programs, along with caps on out-of-pocket spending. These plans can bundle Part D prescription coverage, simplifying plan management for many members, or supplemental plans, also known as Part C plans, which can be purchased independently. However, they may restrict provider access through network limitations, require referrals for specialists, and impose prior authorization for some services. Premiums for Medicare Advantage plans vary; in 2024, the average was $14 per month, though most enrollees paid no premium beyond the Part B cost. Medicare Advantage’s structured approach appeals to those prioritizing cost predictability and additional benefits.

Medicare Advantage and Supplemental plans vary widely. Provider networks differ in size and scope, affecting access to physicians and pharmacies. Extra benefits like dental care or allowances for over-the-counter items are common but vary significantly in scope and value. Out-of-pocket spending caps provide financial protection, with limits averaging $4,882 for in-network services. However, prior authorization requirements can create hurdles to accessing care.

For beneficiaries opting for Part D prescription drug coverage, stand-alone Part D plans offer flexibility in Original Medicare. In 2024, beneficiaries could choose from an average of 21 plans with premiums averaging $43 per month. These plans vary in covered drugs, utilization restrictions, and pharmacy networks. Changes under the Inflation Reduction Act are shaping Part D, introducing a $35 cap on insulin and phasing in a $2,000 annual out-of-pocket cap by 2025.

Ultimately, selecting between Medicare coverage options requires careful consideration of health needs, provider preferences, and financial circumstances. Beneficiaries should weigh the trade-offs of each option to ensure their coverage aligns with their priorities.

How FEDlogic Can Help

With Medicare’s complexities, comparing plans can feel overwhelming. FEDlogic is here to help your employees and their household members understand their options during Open Enrollment. Our team provides unlimited, confidential, and free consultations, assisting them in evaluating their current plans and exploring options—all without selling or promoting products or services to your employees or their family members. Our goal is to help people understand their benefits and make confident choices for the year ahead.

Changes to Medicare Part D Provisions in 2025

The Inflation Reduction Act of 2022 is making significant changes to Medicare Part D to provide financial relief for Medicare beneficiaries by expanding benefits and lowering drug costs.

The Inflation Reduction Act Lowers Out-of-Pocket Prescription Drug Costs 

• Out-of-Pocket Limit. The maximum out-of-pocket limit will decrease from $8,000 to $2,000

• Beneficiary out-of-pocket spending is capped at $2,000 for 2025.

• Some Medicare Advantage plans will reduce benefits or leave markets.

• Please be sure that all your medications are on the formulary of the drug plan. If your medications are not listed, you will pay more than the $2,000 cap.

Medicare Part D Creditable Coverage

Employers who offer prescription drug coverage must distribute a notice of "creditable" or "non-creditable" coverage to Medicare-eligible individuals before October 15th, which coincides with the Medicare Part D open enrollment period, which generally runs from October 15th until December 7th of each year. Medicare-eligible individuals who delay enrollment in Medicare Part D can incur late enrollment penalties unless they have enrolled in other creditable coverage. The employer notice is intended to inform employees of this risk.

Creditable Prescription Drug Coverage

Prescription drug coverage that is expected to pay, on average, at least as much as Medicare drug coverage is considered “creditable” This could include drug coverage from a current or former employer or union, TRICARE, Indian Health Service, VA, or individual health insurance coverage.

Your plan must tell you each year if your non-Medicare drug coverage is creditable coverage. If you go 63 days or more in a row without Medicare drug coverage or other creditable prescription drug coverage, you may have to pay a penalty if you sign up for Medicare drug coverage later.

Changes to Medicare rules and creditable coverage can be confusing for you and your employees and teammates. FEDlogic is here to help answer questions and ensure Medicare decisions are made with current and accurate information.

Win Lunch for Your HR Team During Medicare’s Open Enrollment!

This Open Enrollment season, we’re excited to announce a special opportunity for our HR partners to win lunch for their team—all while helping employees access valuable support from FEDlogic! Our Open Enrollment Referral Challenge makes it simple: every time you refer employees, you’re increasing your chances of winning.

Here’s how it works:

• 1 Entry for every employee consultation.

• 10 Entries for every warm handoff/referral email you send to introduce an employee to FEDlogic.

10 Winners will be randomly drawn at the end of the campaign to win lunch for their entire HR team. It’s our way of showing appreciation for the dedication you put into ensuring employees have access to the guidance they need.

Why Participate?

Open Enrollment can be overwhelming for employees, and a quick introduction to FEDlogic’s services can make a real difference. From benefits consultations to navigating complex eligibility issues, we’re here to provide clarity and support to employees at every step.

How to Join the Challenge:

Referring is easy! Simply submit the referral form on our website through the HR portal or email us at [email protected] to make a warm handoff. You can also encourage employees to sign up for a consultation at their convenience. Each referral counts, and there’s no limit to how many entries you can earn.

At the end of the campaign, we’ll notify the winning teams and coordinate a lunch delivery for your HR department as a big thank-you for your involvement.

Start referring today and give your team a chance to win lunch on us! As always, we’re here to support you and your employees through a successful Open Enrollment season.

ACA Marketplace 2025 Open Enrollment: What You Need to Know

The 12th annual Affordable Care Act (ACA) Marketplace open enrollment season kicks off on November 1, 2024, offering millions an opportunity to secure or adjust their health coverage. With record-high enrollment in recent years, the 2025 enrollment period brings new updates and changes to consider.

Modest Premium Increases with Subsidies Mitigating Costs
While unsubsidized premiums for benchmark silver plans will increase by an average of 4%, most enrollees won’t feel the impact thanks to subsidies. Enhanced subsidies cap monthly premiums based on income, allowing 92% of Marketplace shoppers to find plans under $10 per month. However, these enhanced subsidies, introduced under the Inflation Reduction Act, are set to expire at the end of 2025, potentially doubling costs for many in 2026 unless Congress acts.

More Insurers, Expanded Coverage Options
The 2025 Marketplace features an average of 9.6 insurers per state, the highest in its history. Major players like UnitedHealth Group and Centene are expanding into new states and counties, offering increased choice to 97% of Healthcare.gov enrollees.

Key Dates and Transitions
Open enrollment runs from November 1, 2024, to January 15, 2025, in most states. Exceptions include Idaho (ending December 16) and several states extending to January 31. Additionally, Georgia joins the 20 states operating a State-Based Marketplace in 2025, with Illinois slated to follow in 2026.

Policy Changes and Protections

• Combatting Fraud: New measures address unauthorized plan changes by brokers, ensuring stricter oversight.

• Short-Term Plans Limited: Short-term health plans, now restricted to four months, must include clear disclaimers distinguishing them from comprehensive health insurance.

• Network Adequacy Standards: Starting in 2025, Marketplace plans must meet new appointment wait-time requirements, verified through secret shopper surveys.

Expanded Eligibility and Special Enrollment Updates
For the first time, Deferred Action for Childhood Arrivals (DACA) recipients can enroll in subsidized Marketplace plans starting November 1, 2024, with coverage beginning as early as December 1. Additionally, new rules simplify coverage start dates for special enrollment period selections.

With new options, protections, and opportunities, this enrollment period is vital for those seeking affordable health coverage. FEDlogic is here to help with employee questions about the Affordable Care Act and how to make the best decision for their families. We are here to provide unbiased navigation and support as your employees work to understand their eligibility for benefits. FEDlogic does not sell, endorse, or promote any products or services.

New Client Spotlight: Hazelden Betty Ford Foundation

FEDlogic is proud to welcome the Hazelden Betty Ford Foundation as one of our newest client partners.

The Hazelden Betty Ford Foundation is a national leader in evidence-based, holistic treatment of substance use and co-occurring mental health conditions. Founded in 1949 in Center City, Minnesota, the nonprofit organization now has treatment centers and telehealth services nationwide. In addition to clinical care, Hazelden Betty Ford encompasses a graduate school, a publishing division, a research center, thought leadership and advocacy, professional and medical education programs, and K-12 school-based prevention resources. Through its ongoing commitment to innovation, research, and continuous improvement, Hazelden Betty Ford remains a beacon of healing and hope for individuals, families, and communities.

Thank you for placing your trust in FEDlogic. We look forward to serving your families.

Check out the FEDlogic LinkedIn page for this and all new client features.

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_{DISCLAIMER: The information, education, and advice provided by FEDlogic, LLC (“FEDlogic”) shall be intended for educational purposes only. Each individual’s circumstances are inherently different from those of another, and therefore, the advice given to an individual may result in unintended consequences to another. The information provided by FEDlogic shall not constitute legal, financial, or accounting advice and further shall not be interpreted as advice from the Federal government. While FEDlogic makes every effort to ensure that the information provided by its consultants is up-to-date, useful, and accurate, FEDlogic makes no guarantees and may not be held liable nor responsible for any inaccuracy or detrimental consequence resulting from the information provided. Notwithstanding the foregoing, any errors or omissions discovered by FEDlogic, its agents, or its customers will be addressed and resolved as soon as possible.}