What's New

If you’ve heard the term “donut hole” used when talking about Medicare drug coverage, you might know it hasn’t exactly been a sweet deal. The donut hole was a gap in Medicare Part D plans where, after reaching a certain limit, you had to pay more out of pocket for your prescriptions. For many people, especially those on fixed incomes or managing ongoing health conditions, this extra cost was a real burden. Over time, the Affordable Care Act helped reduce the financial impact, but the gap still caused confusion and stress for many Medicare enrollees.

Now there’s good news: as of January 1, 2025, the donut hole is officially closed. Thanks to a new law called the Inflation Reduction Act, your out-of-pocket costs for Medicare Part D prescription expenses will be capped. Once you spend $2,000 in a year on covered medications, you won’t pay anything more for the rest of that year. This change makes drug coverage much easier to understand—and it offers peace of mind, knowing your medication costs are now more predictable and manageable.

In 2025, Medicare is expanding its mental health coverage to better meet the growing need for accessible care. A key update is the inclusion of more mental health professionals—such as licensed professional counselors, marriage and family therapists, and addiction specialists—under Medicare. This change increases access to care, particularly in underserved and rural areas. Telehealth services, including audio-only options, remain covered, allowing beneficiaries to receive mental health support remotely. Federally Qualified Health Centers and Rural Health Clinics can also continue serving as telehealth providers.

Medicare Part B continues to cover outpatient mental health services like therapy, counseling, and psychiatric evaluations. A notable addition in 2025 is coverage for intensive outpatient program (IOP) services, which offer structured support for those needing more than standard therapy. Medicare has also introduced new billing codes for comprehensive mental health assessments and safety planning services, aimed at improving early detection and suicide prevention.

Medicare Part D now caps annual out-of-pocket prescription drug costs at $2,000 , making medications—including those for mental health—more affordable. Inpatient psychiatric care remains covered under Part A for individuals facing severe mental health crises, including hospital stays, therapy, and medication management. Medicare Advantage plans will reflect these updates as well, so beneficiaries are encouraged to review their options during open enrollment to ensure their mental health needs are fully supported.

The Centers for Medicare & Medicaid Services (CMS) have proposed updates to how the Health Insurance Marketplace operates in 2025, with a focus on improving accuracy and maintaining affordability. The goal of the new rule is to strengthen verification processes, ensure that financial assistance is going to those who are eligible, and keep the system running efficiently.

Key changes would include updates to how income is confirmed during enrollment, adjustments to special enrollment period eligibility checks, and possible changes to Open Enrollment timing. While these may seem like behind-the-scenes tweaks, they’re intended to support a more stable insurance environment—helping the Marketplace continue offering coverage options that work for a wide range of people, including those just aging out of a parent’s plan or buying coverage on their own for the first time.

For more information, visit CMS.gov , and remember that we are always here to help you. Have questions? Don't hesitate to call!