Medicare Changes in 2025: 5 Things Midwest Seniors Need to Know Before Open Enrollment Ends

Open Enrollment ends December 7. If you live in Illinois, Indiana, Michigan, or Wisconsin, here are the five updates that matter most. These changes are chosen during 2025 Open Enrollment and take effect January 1, 2026. Keep this brief guide handy and skim what applies to you.

1. $2,000 cap on Medicare Part D prescription costs (effective 2026)

• After you spend $2,000 out of pocket on covered medications, your plan covers the rest for the year.
• You can “smooth” high drug costs into smaller monthly payments.
• You’ll still pay your premium and any deductible, but the donut hole cost spikes are largely tamed.

2. Medicare Advantage: fewer plans, lower average premiums

• Average choices drop from ~43 to ~34 plans per county; average premium about $17/month.
• Fewer options can simplify decisions—focus on your doctors, medications, and the plan’s out-ofpocket maximum.
• Check extras you actually use (dental, vision, OTC), not just flashy add-ons.

3. Provider networks: verify your doctors for 2026

• Some doctors and hospitals are moving in or out of certain Advantage plans.
• Call your providers or check each plan’s 2026 directory before you switch—or stay.
• If a favorite provider is out-of-network, you can switch plans, choose a new in-network provider, or stay and expect higher costs. Continuity of care is worth prioritizing.

4. Part D plan reshuffles: premiums, deductibles, formularies

• Many drug plans are changing premiums, deductibles, and drug tiers (the list and pricing level of covered meds).
• Some medications may move to higher tiers or need prior authorization—run your exact med list.
• Compare total annual cost (premium + deductible + copays) and pharmacy network, not just the monthly price.

5. Mental health: broader access and easier entry

More counselors and therapists are joining Medicare, including within many Advantage networks.

Review coverage for therapy visits, telehealth, and psychiatric medications; note copays and any visit limits.

Support is more accessible—adding it to your care plan can improve overall well-being.

Quick checklist before December 7

• Make a current list: medications/doses and preferred pharmacies; doctors and hospitals you want to use.
• Read your plan’s Annual Notice of Change and flag what’s different for 2026.
• Use Medicare’s Plan Finder to price your medications under multiple plans.
• Confirm provider networks and total annual costs for your top 2–3 choices.
• Ask about Special Enrollment Periods if your situation changes during the year.

We’re here to help—on your schedule

• Personalized, no-pressure Medicare reviews across IL, IN, MI, and WI.
• Mobile and virtual appointments available; we specialize in complex health histories and chronic conditions.
• Get a free comparison: Medicare planning specialists

You’re not alone. With clear information and a steady plan, you can find coverage that fits your needs and budget—and step into 2026 with confidence and peace of mind.