Insurance Changes for 2025: What Horizon Eye Care Patients Need to Know

North Carolina and South Carolina Insurance Policy Updates for 2025

Changes to insurance policies can impact eye care costs, from exams to surgeries. As premiums, deductibles, and provider networks shift, here’s a summary of what to watch for in 2025.

1. Increased Premiums Across Many Plans
   Premiums for individual and family plans are expected to rise in 2025. North Carolina residents may see an average increase of 6-10%, and similar adjustments are anticipated in South Carolina. These changes affect employer-sponsored and marketplace plans alike, impacting out-of-pocket expenses for patients across the board.
2. Deductible Adjustments and Higher Out-of-Pocket Maximums
   Deductibles are projected to increase for many plans, especially high-deductible options that allow for lower monthly premiums. If you’re on a high-deductible plan, be sure to budget for additional out-of-pocket expenses. Out-of-pocket maximums are also rising, particularly for marketplace plans, as insurers work to offset rising medical costs.
3. Changes to Provider Networks
   Some insurance companies are narrowing their provider networks, which may affect where you can receive care. If Horizon Eye Care is considered an in-network provider, you may benefit from lower co-pays and reduced out-of-pocket expenses. However, check your provider’s network status in 2025 to avoid unexpected costs.

What to Expect with Medicare and Medicaid in 2025

Medicare and Medicaid programs are also experiencing changes. Here's a summary for those on these government-funded plans.

1. Medicare Advantage Changes for Vision Benefits
   In 2025, Medicare Advantage plans are enhancing some vision benefits. Expanded options may include additional allowances for glasses, contacts, and eye exams. However, the coverage varies widely by plan, so check with your insurer for specific details.
2. Medicaid Expansion and Vision Benefits in North and South Carolina
   Both North and South Carolina have taken steps toward Medicaid expansion. This could mean additional eye care coverage for some adults who previously didn’t qualify. Medicaid changes often vary by county and state, so check your eligibility and the scope of your plan’s benefits.
3. Lower Premiums for Some Medicare Part D Plans
   For Medicare patients managing eye health issues that require medication, expect slight premium reductions for Medicare Part D plans. This change can help cover prescription costs for eye conditions.

Expanded Options and Resources for Patients with Employer-Sponsored Plans

Employer-sponsored plans will see policy updates in 2025, including expanded options for eye care benefits. Here's what you need to know if you're covered under an employer’s health plan.

1. Flexible Spending and Health Savings Account Adjustments
   Annual contribution limits for Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) will increase in 2025. This adjustment offers more tax-free funds that can be set aside for medical and eye care expenses. If you have ongoing eye care needs, consider maximizing these accounts to cover costs.
2. Vision-Specific Plans
   Many employers are expanding access to vision-specific insurance plans. These plans often include annual exams, discounts on eyewear, and other valuable benefits. Be sure to review options during open enrollment periods to choose a plan that best fits your eye care needs.

Preparing for Insurance Changes in 2025

Navigating insurance changes for 2025 may feel overwhelming. Start by reviewing your current coverage, premiums, and out-of-pocket maximums. Look closely at your provider network and verify if Horizon Eye Care remains in-network under your plan. This means not only checking for your doctor but also the surgical centers where he or she has privileges. This is especially important when switching plans but is still worth checking when your plan renews. The North Carolina Department of Insurance offers resources to help you understand changes in the marketplace. They provide tools to compare plans and costs, so visit their website for further assistance.

Be proactive during open enrollment by reviewing your benefits. If your plan doesn’t meet your needs, consider alternatives. Discuss any questions with our knowledgeable team at Horizon Eye Care.

Insurance is a constantly changing landscape. For the latest information about our accepted insurance plans, visit our Costs and Insurance page which is continuously updated throughout the plan year as we receive changes.

For an appointment at Horizon Eye Care, schedule online any time or call 704-365-0555 Monday-Thursday, 8 a.m. to 5 p.m., or Friday, 8 a.m. to 3 p.m. The optical department closes on Fridays at 2:30 p.m.