Medicare Open Enrollment: What Your Employees Need to Know

The Medicare Open Enrollment Period, running from October 15th to December 7th, is an annual opportunity for Medicare recipients to review and adjust their healthcare plans for the upcoming year. This critical window allows beneficiaries to ensure their coverage is both cost-effective and aligned with their healthcare needs.

What is the Medicare Open Enrollment Period?

During this time, Medicare enrollees can:

• Add or drop a Medicare Part D prescription drug plan

• Switch from Original Medicare (Parts A and B) to a Medicare Advantage plan

• Change from one Medicare Advantage plan to another

• Return to Original Medicare from a Medicare Advantage plan

• Select a new Medicare Part D plan

Why Reevaluate Coverage?

Medicare plans often change annually, impacting monthly premiums, deductibles, and out-of-pocket costs for prescriptions. Starting in 2025, some employer health plans may also no longer qualify as "credible coverage" under Medicare Part D, which could affect beneficiaries’ prescription drug choices.

Reevaluating coverage each year helps beneficiaries:

• Find a Part D plan that better fits prescription needs, potentially saving money

• Ensure preferred doctors remain in-network to control costs

• Discover plans that offer better coverage for a similar price

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.

What is a “Benefits Cliff?”

A benefits cliff, or "cliff effect," occurs when a slight increase in earnings unexpectedly results in a loss of public assistance, leaving families financially worse off despite earning more. This effect often impacts households relying on essential programs like food assistance, Medicaid, and housing support. For many low-income workers, particularly those making between $13 and $17 per hour, the benefits cliff becomes a significant barrier to economic advancement.

How It Works

Benefits cliffs happen because public assistance programs set fixed income limits for eligibility. When a person’s income crosses these limits, they lose benefits abruptly, leading to a net decrease in their overall resources. For instance, a single parent receiving housing and childcare support might lose access to these programs with a small pay raise, which may not cover the cost of the lost benefits. This creates a paradox where wage increases can actually harm financial stability, discouraging career growth and economic mobility.

The Impact on Families and Employers

Benefits cliffs create challenges for families, employers, and the broader economy. Affected families experience financial instability, with some reducing work hours or declining promotions to stay eligible for assistance. For employers, benefits cliffs can lead to reduced workforce availability and a disincentive for employees to advance, impacting organizational growth and productivity.

How FEDlogic Can Help

Understanding and navigating benefits cliffs can be complex. FEDlogic supports individuals and families by helping them understand the eligibility rules for various assistance programs, including how changes in income might affect benefits. With FEDlogic’s guidance, employees can make informed decisions about career and wage growth, allowing them to plan for the loss of benefits and take steps toward financial independence. This support empowers families to make better-informed decisions about work and personal finances without being blindsided by sudden financial setbacks.

Public Assistance Programs and Cliffs

Benefits cliffs affect several key assistance programs, each with specific income criteria:

1. Housing Assistance: Programs like the Housing Choice Voucher have strict income caps based on area median income, so even a slight income gain can result in a loss of benefits.

2. Food and Nutrition Programs: Supplemental Nutrition Assistance Program (SNAP) benefits can be reduced or lost entirely when household income surpasses certain levels.

3. Healthcare Programs: Medicaid and CHIP provide critical healthcare support but impose income limits that can trigger benefits cliffs, making healthcare unaffordable if benefits are lost.

4. Cash Assistance Programs: Temporary Assistance for Needy Families (TANF) and Supplemental Security Income (SSI) impose income restrictions that can impact financial stability if benefits are abruptly removed.

5. Utility and Childcare Assistance: Programs like LIHEAP and the Child Care and Development Fund (CCDF) also have eligibility limits that affect households as their income changes.

State-Level Responses

Recognizing the impact of benefits cliffs, 25 states and the District of Columbia have introduced legislation to soften their effects. Some states are implementing phased reductions in benefits as income rises, allowing families to maintain stability while transitioning toward financial independence.

With FEDlogic’s assistance, employees can confidently navigate these complexities and gain clarity on how to achieve long-term financial security.

New Client Spotlight: W.T. Walker, Inc.

FEDlogic is proud to welcome W.T. Walker, Inc. as one of our newest client partners.

Founded in 1950, WT Walker Inc. has grown into an industry leader known for its extensive forging capacity, advanced metallurgical expertise, and deep commitment to customer success. Under third-generation leadership, Walker continues to invest in new equipment and innovative solutions, supporting both their clients and Wisconsin communities. Walker’s customer-focused team and strong financial foundation have established enduring client relationships and a culture of continuous improvement, keeping them at the forefront of the industry.

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.}