Big changes are coming to Medicare you need to know

WARREN, Ohio (WKBN) – There are big changes coming to Medicare and if you are a recipient, you don’t want to be asleep at the wheel or it could cost you more than you know.

The experts at TLC Insurance Group in Warren say the most important thing you can do is get a review so you understand what’s happening.

“Some of the largest changes that are happening due to the Inflation Reduction Act are going to actually occur on January 1 of 2025,” said Craig Villwock, co-owner of TLC Insurance Group. “There’s significant changes coming for every senior on Medicare, and seniors should realize that their plan will be impacted regardless of what kind of plan they’re on.”

Those impacts can really affect your bottom line and the clock is ticking.

“Their plan will be affected on price. It will be affected potentially on drugs covered or not covered, and also whether or not they should remain on that plan or switch to another one. So I think the most important thing that we need to push into people’s heads is that every single person who has Medicare has to get a review,” said Villwock. ” This year, more than ever because it’s going to be important to make sure you’re on the right plan, going into 2025.”

Getting a review from TLC Insurance Group is easier than you think.

“Everyone should be aware that they need to review, first of all. You know, so many changes have happened, but the best way to get a review is to call somebody they trust and know,” said Villwock. “I would reach out to somebody who has all the plans available, not just an agent or broker that has maybe one carrier that they only work with.”

Getting a review is so important because there are so many changes across the universe of Medicare.

“They need to look at all plans available because one plan might show better than the other,” said Villwock. “According to their current prescriptions they take, doctors, etc. for 2025.”

And it’s important to remember that no one plan is right for everyone.

“Everyone’s different on the prescriptions. They take the doctors they use, and the plans themselves have significantly changed next year,” said Villwock. “The prescription change that was forced by the Inflation Reduction Act, that’s not only changing the prescription possibilities for every single person on Medicare, but it’s also changing the plan benefits potentially.”

Villwock says insurance carriers have had to make tough decisions.

“You know, it’s like, do I raise premiums on prescriptions or do I leave that the same and potentially take away from other parts of the plan, including plan benefits, doctor co-pays, co-insurance?” he said. “Sometimes we’ve seen already going into 2025, some local plans right around here have reduced planned benefits like dental and vision that retirees and seniors have been used to having.”

It’s also important to know that you can’t just roll whatever plan you are on over.

“Nobody can take it for granted this year,” said Villwock. ” In 25 years in doing Medicare, this is the biggest change we’ve seen. Not only what we expected, but now what we’re actually seeing once we’re able to review them after October 1. So for everybody out there, you have the time to review right now so you can actually start looking at your plan right now.”

You can actually enroll in a plan during the annual election period for Medicare from October 15 until December 7 to be effective on January 1.

“Even if your individual situation has not changed, even if your prescriptions haven’t changed and you think everything’s fine, you cannot take that for granted this year because what we’re seeing now is in individual reviews that were already taking place, we’re seeing that people who had no changes to their personal lifestyle, their personal prescriptions, we’re seeing potential changes where the prescription they’re covered on in 2024 is not covered at all in 2025.

If you don’t get the review, significant changes could happen you may not be aware of.

“What used to be an unlimited out-of-pocket maximum for people who had very, very high prescriptions is now limited to $2000 out of pocket. The formulation at $2000 is very confusing,” said Villwock. “I’ve been training on it around the country and it’s confusing how it gets there. But the bottom line is $2,000 maximum out-of-pocket for anybody who’s on Medicare for the prescription cost.”

Some things you may be used are also going away.

“So they got rid of the donut hole. Everybody had heard about donut hole as always a very negative part of prescription drugs. The donut hole has been eliminated,” said Villwock. “So once a person on Medicare spends $2,000 potentially out of pocket, which they call true, true out-of-pocket expenses, then they are covered 100% for the balance of that year on their prescription drugs.”

Bottom line? Get a review.

“We’re telling everybody, we highly suggest you get a review with somebody you trust. If you wanted to be through TLC, we would love that. There’s no obligation with us ever,” said Villwock. “We’re going to be on a free consultation. There’s no cost for our services whatsoever. We’re here to help and we’re here local and we’d love to help.

TLC Insurance Group is located at 8775 East Market Street in Warren. Call (800)719-3751 and visit them online at TLCInsuranceGroup.com. You can also find them on Facebook.

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