Medicare Benefit plans, which enrolled practically 33 million Medicare beneficiaries or 54% of the eligible Medicare inhabitants in 2024, as a result of they sometimes provide further advantages, resembling dental, imaginative and prescient and listening to, typically for no extra premium, in addition to decrease price sharing in comparison with conventional Medicare with out supplemental insurance coverage, with the trade-off of extra restrictive supplier networks and higher use of price administration instruments, resembling prior authorization.
This temporary gives an outline of premiums and advantages in Medicare Benefit plans which can be obtainable for 2025 and key tendencies over time. This temporary makes use of information from the CMS Panorama and Profit information. See strategies for extra particulars. Usually, this temporary refers to Medicare plans obtainable for basic enrollment, excludes Particular Wants Plans (SNPs), besides the place famous, and excludes employer plans. A companion evaluation describes tendencies in plan choices.
Medicare Benefit Highlights for 2025
Two-thirds of all Medicare Benefit plans with Half D prescription drug protection (MA-PDs) (67%) will cost no premium (aside from the Half B premium) in 2025, much like 2024 (66%).
Almost one-third (32%) of Medicare Benefit plans will provide some discount within the Medicare Half B premium in 2025, a rise in comparison with 2024 (19%).
Almost all Medicare Benefit plans (97% or extra) are providing imaginative and prescient, dental and listening to, as they’ve in earlier years. Nonetheless, the share of plans providing sure advantages has declined, resembling over-the-counter advantages (85% in 2024 vs. 72% in 2025), distant entry applied sciences (74% in 2024 vs. 53% in 2025), meal advantages (72% in 2024 vs. 65% in 2025) and transportation (36% in 2024 vs. 29% in 2025).
The share of Particular Wants Plans (SNPs) providing transportation, distant entry applied sciences and in-home help providers declined barely in 2025, whereas the share providing rest room security units and the Half B rebate elevated.
A bigger share of SNPs than different Medicare Benefit plans are providing Particular Supplemental Advantages for the Chronically Unwell, that are further advantages obtainable to a subset of a plan’s enrollees, significantly meals and produce (84% in SNPs; 15% in particular person plans) and basic helps for residing, resembling housing and utilities (67% in SNPs; 11% in particular person plans).
Premiums
The overwhelming majority of Medicare Benefit plans for particular person enrollment (89%) will embrace prescription drug protection (MA-PDs), the identical as in 2024, and the share of MA-PDs that cost no premium (aside from the Half B premium of $185 monthly) is 67% in 2025, much like 2024 (66%). Almost all beneficiaries (99%) have entry to a MA-PD with no extra month-to-month premium in 2025, the identical as in 2024 (99%).
In 2024, 75% of enrollees in MA-PD plans pay no premium aside from the Medicare Half B premium. Based mostly on enrollment in March 2024, 10% of enrollees pay at the least $50 a month, together with 3% who pay $100 or extra. CMS estimates that the common month-to-month plan premium amongst all Medicare Benefit enrollees in 2025, together with those that pay no premium for his or her Medicare Benefit plan, might be $17.00 a month. In 2024, 12 % of Medicare Benefit enrollees are in a plan that provided some discount in Medicare Half B premiums.
In 2025, 32% of Medicare Benefit plans will provide some discount within the Half B premium, increased than the share in 2024 (19%) (Determine 1).
Amongst plans which can be providing a month-to-month discount within the Half B premium ($185 monthly in 2025), 28% are providing a month-to-month discount of $100 or extra, 25% are providing a discount of $50.01 to $100, 17% are providing a discount of $10.01 to $50, and 30% are providing a month-to-month discount of $10 or much less.
In earlier years, a smaller share of Medicare Benefit enrollees has sometimes ended up in plans that decreased the Half B premium. For instance, for the 2024 plan 12 months, 19% of plans provided a discount within the Half B premium, however finally solely 12% of Medicare Benefit enrollees had been enrolled in plans with this profit.
Whereas many employers and unions additionally provide Medicare Benefit plans to their retirees, no details about these 2025 plan choices is made obtainable by CMS to the general public through the Medicare open enrollment interval. Employer and union plans are administered individually and should have enrollment intervals that don’t align with the Medicare open enrollment interval.
Additional Advantages
Medicare Benefit plans could present further advantages that aren’t obtainable in conventional Medicare, are thought of “primarily well being associated,” and might use rebate {dollars} (together with bonus funds) to assist cowl the price of these further advantages. Starting in 2019, CMS expanded the definition of “primarily well being associated” to permit Medicare Benefit plans to supply extra supplemental advantages. Medicare Benefit plans may additionally prohibit the supply of those further advantages to sure subgroups of beneficiaries, resembling these with diabetes or congestive coronary heart failure, making completely different advantages obtainable to completely different enrollees.
Availability of Additional Advantages in Particular person Plans for Normal Enrollment. In 2025, 97% or extra particular person plans provide some imaginative and prescient, dental or listening to advantages, much like 2024 (Determine 2). Although these advantages are broadly obtainable, the scope of protection for these providers varies. For instance, a dental profit could embrace cleanings and preventive care or extra complete protection, and sometimes is topic to an annual greenback cap on the quantity lined by the plan. From 12 months to 12 months, plans could change the parameters of this protection, resembling growing or lowering annual maximums the plan can pay towards the profit or adjusting price sharing for providers. There may be not but information obtainable about utilization of those advantages or related prices, so it’s not clear the extent to which supplemental advantages are utilized by enrollees.
As of 2020, Medicare Benefit plans have been allowed to incorporate telehealth advantages as a part of the essential profit bundle – past what was allowed beneath conventional Medicare previous to the COVID-19 public well being emergency, which was prolonged to December 2024. Subsequently, these advantages usually are not included within the determine above as a result of their price is just not lined by both rebates or supplemental premiums. Medicare Benefit plans may additionally provide supplemental telehealth advantages through distant entry applied sciences and/or telemonitoring providers, which can be utilized for these providers that don’t meet the necessities for protection beneath conventional Medicare or the necessities for the telehealth advantages as a part of the essential profit bundle (such because the requirement of being lined by Medicare Half B when offered in-person). In 2025, 53% of plans are providing distant entry applied sciences, a decline from 74% in 2024. An identical share of plans are providing telemonitoring providers (2% in 2025 vs 3% in 2024).
Some advantages are being provided by a smaller share of plans in 2025 than in 2024. For instance, 72% of plans are providing an allowance for over-the-counter objects (vs. 85% in 2024), whereas 65% are providing meal advantages (vs. 72% in 2024), and 29% are providing transportation advantages for medical wants (vs. 36% in 2024). An identical share of plans is providing acupuncture (32% in 2025 vs. 34% in 2024), rest room security units (24% in 2025 vs 22% in 2024), and help for caregivers of enrollees (5% in 2025 and 2024). A smaller share of plans are providing in-home help providers (6% in 2025 vs 9% in 2024). This isn’t an exhaustive record of additional advantages that plans provide, and plans could present different providers resembling home-based palliative care, therapeutic therapeutic massage, and grownup day well being providers, amongst others.
Entry to Medicare Benefit Plans with Additional Advantages. Just about all Medicare beneficiaries dwell in a county the place at the least one Medicare Benefit plan obtainable for basic enrollment (excluding SNPs) has some further advantages not lined by conventional Medicare, with over 99% getting access to at the least a number of plans with dental, health, imaginative and prescient, and listening to advantages for 2025, the identical as in 2024. The overwhelming majority of beneficiaries even have entry to a number of plans that provide an allowance for over-the-counter objects (over 99%), a meal profit (over 99%), distant entry applied sciences (99%), acupuncture (98%), rest room security units (96%), transportation help (94%) however fewer have entry to a number of plans that provide in-home help providers (60%), caregiver help (41%), or telemonitoring providers (16%). (Connecticut is just not included in these estimates – see strategies for extra particulars.)
Availability of Additional Advantages in Particular Wants Plans. SNPs are designed to serve a disproportionately high-need inhabitants, and a considerably bigger share of SNPs than plans for different Medicare beneficiaries present their enrollees over-the-counter advantages (92%; much like 2024 – 94%), transportation advantages for medical wants (81%; a decline from 88% in 2024), meals (73%, much like 2024 – 75%), rest room security units (54%; up from 34% in 2024), and in-home help providers (17%; down from 25% in 2024) (Determine 3). In comparison with particular person plans, a smaller share of SNPs provide health advantages (83%, much like 2024 – 84%), distant entry applied sciences (49%; a decline from 66% in 2024), and the Half B rebate (29%; up from 7% in 2024). Much like plans obtainable for particular person enrollment, a comparatively small share of SNPs provide help for caregivers (5%) or telemonitoring providers (2%).
Availability of Particular Supplemental Advantages for the Chronically Unwell (SSBCI). Starting in 2020, Medicare Benefit plans have additionally been in a position to provide further advantages to a subset of a plan’s enrollees, that aren’t primarily well being associated and are particularly for chronically unwell beneficiaries, often known as Particular Supplemental Advantages for the Chronically Unwell (SSBCI). As well as, Medicare Benefit plans taking part within the Worth-Based mostly Insurance coverage Design Mannequin may additionally provide these non-primarily well being associated supplemental advantages to their enrollees, however can use completely different eligibility standards than required for SSBCI, together with providing them primarily based on an enrollee’s socioeconomic standing (e.g., LIS eligibility) or whether or not the enrollee lives in an underserved space.
Most particular person and SNP Medicare Benefit plans nonetheless don’t provide these advantages, although extra SNP plans usually provide these advantages, significantly meals and produce. SSBCI advantages provided in 2025 embrace meals and produce (15%% for particular person plans and 84% for SNPs), basic helps for residing (e.g., housing, utilities) (11% in particular person plans and 67% for SNPs), transportation for non-medical wants (8% for particular person plans and 46% for SNPs), and pest management (3% for particular person plans and 23% for SNPs) (Determine 4).
Like for different varieties of supplemental advantages, the scope of providers for SSBCI advantages varies. For instance, many plans provide a specified greenback quantity that enrollees can use towards quite a lot of advantages, resembling meals and produce, utility payments, lease help, and transportation for non-medical wants, amongst others. This greenback quantity is commonly loaded onto a flex card or spending card that can be utilized at taking part shops and retailers, which might fluctuate relying on the seller administering the profit. Relying on the plan, this can be a month-to-month allowance that expires on the finish of every month or rolls over month to month till the tip of the 12 months, when any unused quantity expires.
Meredith Freed, Jeannie Fuglesten Biniek, and Tricia Neuman are with KFF. Anthony Damico is an impartial advisor.
Strategies
This evaluation focuses on the Medicare Benefit market in 2025 and tendencies over time.
Knowledge on Medicare Benefit plan availability, enrollment, and premiums had been collected from a set of knowledge information launched by the Facilities for Medicare & Medicaid Companies (CMS):
Medicare Benefit plan panorama information, launched every fall previous to the annual enrollment period- Medicare Benefit plan crosswalk information, launched every fall
Medicare Benefit contract/plan/state/county degree enrollment information, launched on a month-to-month foundation
Medicare Benefit plan profit bundle information, launched quarterly
Medicare Enrollment Dashboard information, launched on a month-to-month foundation
Connecticut is excluded from the Entry to Medicare Benefit Plans with Additional Advantages part of this evaluation because of a change in FIPS codes which can be within the Medicare Enrollment Dashboard information however usually are not but mirrored within the Medicare Benefit enrollment information. Some Alaskan counties are additionally excluded because of variations in FIPS codes.
In earlier years, KFF had calculated the share of Medicare beneficiaries enrolled in Medicare Benefit by together with Medicare beneficiaries with both Half A and/or B protection. We modified our method in 2022 to estimate the share enrolled amongst beneficiaries eligible for Medicare Benefit who’ve each Medicare Half A and Medicare B. These adjustments are mirrored in all information displayed trending again to 2010.
Moreover, in earlier years, KFF had used the time period Medicare Benefit to confer with Medicare Benefit plans in addition to different varieties of non-public plans, together with price plans, PACE plans, and HCPPs. Nonetheless, price plans, PACE plans, HCPPs are excluded from this evaluation along with MMPs. These exclusions are mirrored in all information displayed trending again to 2010.
KFF’s plan counts could also be decrease than these reported by CMS and others as a result of KFF makes use of total plan counts and never plan segments. Segments usually allow a Medicare Benefit group to supply the “identical” native plan, however could fluctuate supplemental advantages, premium and value sharing in several service areas (usually non-overlapping counties).
