5 Simple Stress Relief Techniques Backed by Science

Life is stressful, and sometimes, there’s no way to avoid the things causing it. Stress, or our natural response to overwhelming situations [1], can feel like a burden when it piles on top of work, family, and personal responsibilities. However, this doesn’t mean there’s nothing you can do to alleviate some of its impacts on your mental and physical health. Having stress relief techniques in your back pocket can be extremely helpful for improving your well-being. In this blog post, we will dive into 5 simple stress relief techniques backed by scientific evidence. Try them out and see if they work for you!

How Simple Tricks Help Your Body

When something overwhelming happens, our bodies automatically have a stress response. This is known as the “fight or flight” reaction, and is a survival instinct that prepares your body to either face the stressor head-on, or run away from it [2]. This response is like your body’s alarm system—it alerts you when something may be dangerous, and signals you to act fast to stay safe. For instance, if you randomly encountered a bear on your walk home, your “fight or flight” response would alert you to quickly decide to stand your ground or run away from the threat. Most of the time, you deal with less dangerous daily stressors than encountering a wild animal, but your stress response alerts you all the same. When this happens, your body gears up to take action by breathing faster, increasing your heart rate, dilating your pupils, and heightening your alertness [3].

Although your body’s natural stress response is designed to keep you safe, prolonged exposure to stress can take a toll on your mental and physical health, ultimately leading to health problems [4]. Many years of research have attested to chronic stress—or stress that lasts a long period—contributing to health issues like high blood pressure and a weakened immune system, as well as susceptibility to stroke, heart attack, and other medical emergencies [5].

If hearing about these long-term effects stresses you out even more, fear not—there are methods you can use to decrease your stress levels. Some methods take more work, but many are simple and can be mastered with some practice. Keep reading to learn more!

Stress Relief Techniques: Feel Less Stressed

Before we jump into the stress-relief techniques themselves, it’s first important to acknowledge the root of your stress. One of the best ways to do this is to seek support from a professional. By visiting your primary care doctor, a mental health specialist, and/or a therapist, you can start to dig deep into your mental health and discover the potential root cause of your stress. Nowadays, there are options to attend these consultations virtually, which alleviates the stress of having to travel to an in-person appointment, find a babysitter for the kids, or navigate an unfamiliar location [6].

For many individuals, chronic conditions cause a great deal of stress [7]. The physical pain, financial issues, and unpredictability of their condition may leave them feeling stressed out and powerless. This can be extremely difficult to deal with alone, which is why chronic disease management check-ins are especially important for these individuals.

Focus on Your Breathing:

Deep breathing techniques can work wonders for reducing your stress levels and returning your body to a calm state. Deep breathing activates the body’s parasympathetic nervous system, which is responsible for regulating your body and keeping it calm and restful [8].

Deep breathing may seem self-explanatory, but there are some specific breathing patterns and techniques you can use to calm your body. A useful breathing technique is called “Boxed Breathing” [9]. To practice this, start by sitting comfortably or lying down with your arms by your side. Close your eyes and try to release any tension in your body. Breath in slowly through your nose while counting 4 seconds. Hold your breath for another 4 seconds. Then, slowly breathe out through your mouth for 4 seconds. Pause for another 4 seconds, and then repeat the process as many times as you wish. You’ll find that this helps your body and mind relax [10].

Relax your muscles

Progressive muscle relaxation works to reduce stress and anxiety by tensing and then releasing tension from a muscle to relax the body [11]. This allows you to focus on each muscle in your body and relax it, promoting a sense of calm throughout the body and mind. To do this, direct your attention to the areas of your body that feel tense, one at a time. This may be your furrowed forehead, clenched jaw, or sore shoulders. Squeeze and tense the muscles in your chosen part for 15 seconds, then release for 30 seconds [12]. Continue to release the tension as much as possible, and recognize how relaxed this part feels. Then, move on to a different part.

Meditate [13]

Meditation certainly takes practice, but once you get the hang of it, it can reduce stress drastically. Meditation helps alleviate stress by promoting a state of inner peace and mindfulness. Although some stress occurs when there is an immediate danger in front of us, a lot of stress also occurs when we worry about the future or the unknown. Mindfulness helps reduce this by forcing us to focus solely on the present moment. This can especially help if you feel overwhelmed or unsure about the future.

Guided meditations may be helpful for beginners. These meditations are led by someone, like a teacher, who directs you to focus on what’s around you. They may ask you to hone in on your senses—what you can see, hear, smell, touch, or taste. They may also ask you to picture a calm and serene location, and imagine you’re there. With practice, you can try to meditate and get into this state of calm on your own.

Get Active and Exercise

Exercise is an incredible way to keep your mind and body healthy and happy. Exercise works as a stress reliever because it increases chemicals in your brain called “beta-endorphins,” which are known to heighten positive feelings and decrease feelings of pain [14]. Even the lightest exercises, like taking a casual walk around your neighborhood, can benefit your mental health.

If you are not used to exercising regularly, take things slow at first—try simple, low-impact exercises like walking, jogging, riding a bike, yoga, or tai chi for 15-30 minutes a day [15]. Once you’ve found your footing, you can work your way up to other forms of exercise, if you’d like! Remember, the goal is to integrate movement into your everyday routine to help relieve stress.

If you have any health conditions that may affect your ability to do certain exercises, speak with your doctor before creating an exercise routine. They can recommend exercises that will work well for you.

Laughter

Believe it or not, an action as simple as laughing can reduce the physical effects of stress. When you laugh, you increase your heart rate and then decrease it, causing an all-natural form of stress relief [16]. It can also stimulate your body’s circulation and relax its muscles, helping you feel less tense—a physical symptom often seen in individuals with high stress levels [17]. Finally, laughter helps your brain release more feel-good endorphins, which can make you feel more positive and relaxed [18]. What makes you laugh? Is it your family, pet, or favorite television show? Whatever it may be, try to work more of it into your daily routine!

Making Stress Relief a Part of Your Day

Consistency is key when it comes to practicing stress relief. It’s best to practice stress relief techniques a little bit each day, instead of waiting for an intense stressful situation to occur. Remember, everyone is different, so something that may work to relieve the stress of someone else may not work the best for you. Try out the techniques above and see which works well for you and fits into your lifestyle. Once you start regularly incorporating these techniques into your habit, you’ll find that they become a natural part of your day!

Conclusion

Even the simplest of techniques, like breathing, taking a walk, and laughing, can do wonders for stress relief. If you find yourself struggling with stress and anxiety, try these techniques out and see how you feel after incorporating them into your daily routine. And if you’d like extra support, we are here to support you through every step of your stress-relief journey.

Resources Used:

How to Talk to Your Doctor About Stress & Anxiety

We all feel stress and anxiety from time to time; it’s a part of the human experience [1]. But, when your stress and anxiety start to take a toll on your mental wellbeing and prevent you from feeling content in your everyday life, it’s smart to speak with a professional about it. Therapists and psychiatrists are trained to tackle mental health issues like these, but your primary care doctor can also be a great resource to speak to about your concerns. They can address your feelings in relation to your health history, and can help diagnose a potential condition, make treatment recommendations, and provide advice on dealing with stress and anxiety [2]. They can also direct you toward a mental health practitioner who would work well with your needs. Although you may be hesitant to bring up your mental health at your next primary care appointment, keeping this a secret is never the right path. Sharing your struggles and asking for help is a sign of strength and taking control over your health.

Prepare for Your Doctor’s Appointment

If you’ve been experiencing a lot of stress and anxiety in your day-to-day life, your mind likely feels overwhelmed. Maybe it’s full of racing thoughts that never seem to halt. Or, perhaps you’re so overwhelmed by your emotions that your head feels cloudy and numb. Whatever you are feeling, know that talking about it is the first step in getting the help you deserve. Prepare for your doctor’s appointment by writing down your feelings as they arise, instead of depending on your memory at the actual appointment.

Stress and anxiety can fluctuate [3], and you may be feeling great the day of your appointment. Because of your calm mood, you may simply forget about all the hard times you’ve been having lately and push this matter under the rug. By preparing ahead of time and writing down how you feel when you are anxious and what triggers your stress, you have something concrete to reference during your appointment.

Think about when your anxiety and stress arise most often—is it in the morning, right when you wake up? Is it at night while you lie in bed? Or, is it throughout the work day? Additionally, note some of the sensations that come with these feelings. Do you experience a fast heart rate, sweaty palms, or shortness of breath [4]? Or, maybe you feel dizzy, unable to concentrate, or panicked [5]? These can all be symptoms of mental health conditions that your doctor should be made aware of.

Questions to Ask Your Doctor About Anxiety

Before you speak with your doctor about your anxiety and stress levels, write down a list of questions that may help you gain the clarity you need. Remember, your doctor is trained to help you understand your feelings and address your concerns. Never hesitate to share your thoughts and questions, and don’t worry about asking too much. There’s no such thing as too many questions at the doctor’s office! Some ideas for questions include:

“Is it possible I have an anxiety disorder? What type of anxiety disorder could this be?”
“What are the possible causes of what I’m feeling?”
“What are my treatment options?”
“Are there any lifestyle changes that might help?”
“Should I see a specialist, like someone who focuses on mental illness?”
“What are the potential side effects of any medications you might recommend?”
“How often will we check in on how I’m feeling?”

Your doctor’s responses will help you gain insight into your potential condition and will likely help you feel more comfortable navigating it moving forward. They may be able to recommend specialists you should speak to or guide you through some lifestyle adjustments that may help alleviate your anxiety.

Stay Connected With Your Doctor

It’s important to find a doctor with whom you feel comfortable talking about vulnerable topics, like mental health. Your primary care physician is a great starting point, especially if this issue is new to you and you already feel fairly comfortable with them. However, you should also feel inclined to ask for referrals to mental health specialists who can provide more in-depth care and expertise on your condition of concern. Your primary care doctor will likely be able to help you recognize whether your feelings indicate an anxiety disorder and introduce some lifestyle habits or medications that may help, which may feel like enough for you. But, many individuals may require more extensive care, especially if your condition is more severe [6]. A mental health practitioner specializing in anxiety can provide many more resources and a deeper understanding of the condition.

Whether you are seeing your primary care physician or a mental health specialist to care for your mental health, one thing is key for success: communication. Ongoing communication, follow-up appointments, and honesty are important parts of managing your conditions effectively. This will help you get the most out of your appointments.

Understanding Diagnosis and Treatment Options

The diagnosis and treatment journey may feel daunting at first, but it’s a necessary path for caring for your mental health. Fortunately, your healthcare provider will be there for you every step of the way. In this section, we’ll outline the common process of diagnosing and treating anxiety.

The journey to diagnosis typically starts with a conversation between you and your primary care physician about how you’ve been feeling and potentially having your provider administer a questionnaire such as the GAD-7. From there, if they feel like your experiences may indicate an anxiety disorder, your primary care provider can diagnose and treat your anxiety or they may refer you to a mental health specialist [7]. Your first appointment with your mental health specialist is called an intake appointment [8]. In this appointment, the specialist will conduct a psychological evaluation. This may sound scary, but it only involves a more detailed conversation about your symptoms, your family history with mental health conditions, and how much your symptoms are affecting your life [9]. Your specialist will consider your responses and schedule a follow-up appointment to discuss your diagnosis, if any. From there, the two of you will discuss whether you’d like to move forward with therapy, or possibly medication, if they see fit. Remember, psychiatrists mostly deal with prescribing medication (though they may provide some therapy) and therapists mainly provide counseling [10].

Treatment can look different for people. It all depends on the severity of your condition and what helps support you the most. For many, therapy helps work through emotional blocks, finding the root cause of your issues and learning healthy coping mechanisms. There are many types of therapy focusing on different methods of improving your mental health. Some of the most common types of therapy for improving anxiety include Cognitive Behavioral Therapy (CBT) and Exposure Therapy [11], but there are many other modes of therapy that may be successful.

Your specialist may recommend that you consider taking medication to lessen your symptoms of anxiety. Anxiety disorders can be caused by a chemical imbalance in the brain, and medications like Selective Serotonin Reuptake Inhibitors, or SSRIs, can help balance out the hormones contributing to your symptoms [11]. Although many may feel hesitant to take medication for their anxiety, studies found that medication intervention was more successful than psychotherapy alone for treating mental health disorders [12].

Another treatment method your specialist will recommend is changing unhealthy lifestyle choices. Factors like poor diet, lack of exercise, and not getting enough sleep can contribute to mental health issues [13]. Therefore, your specialist can help you create a plan to improve on these lifestyle choices.

No matter what treatment path you end up taking, make sure to consistently communicate with your doctor and specialist about what is and isn’t working.

Struggling with mental health issues like stress and anxiety can be extremely difficult, but you don’t have to go through it alone. Your doctor is there to provide insight, advice, and referrals to help improve your mental health and support you throughout your journey. Preparing ahead of your appointment can help you feel more confident during your conversation with your doctor, and ensure you don’t forget any important points you wish to address. Remember, the end goal is to work with your doctor as a team and find a treatment plan that works best for your needs. Book an appointment with Greater Good Health today if you’re a senior who would like to discuss symptoms of anxiety and stress.

References Used:

The Future of Primary Care: How AI and Telehealth Are Transforming Medicare Services in 2025

In our ever-changing landscape of technology, Artificial Intelligence (AI) has become a valuable asset in the world of healthcare, telehealth, and Medicare. AI has improved healthcare in a multitude of ways, including making diagnosis, treatment, and patient-care more efficient and user-friendly. In this blog, we’ll dive into how AI and telehealth are transforming Medicare services in 2025, and what these changes mean for you and your services.

The Rise of Telehealth in Medicare

“Telehealth” is the use of technology to assist with healthcare services for patients and healthcare providers [1]. At one point in time, in-person appointments may have been the only option available, making healthcare services difficult to attain for some individuals. Now, telehealth is the new norm—and healthcare services can be accessed from the comfort of your home through the use of technology.

The use of telehealth rose during the COVID-19 global pandemic, as patients weren’t able to visit doctor’s offices to receive services due to social distancing protocols. In fact, there was a 154% increase in telehealth visits during the last week of March 2020 compared to the same period in 2019, which illustrates the degree of this rise [2].

The growing use of telehealth was made possible due to necessary policy changes to accommodate technology-driven appointments during the pandemic. For example, policies on HIPAA changed to allow healthcare providers to administer support through platforms like Zoom, and Medicare policies expanded to allow coverage for telehealth visits [3].

In 2025, most healthcare providers are back to offering in-office visits. However, many continue to offer telehealth services due to the convenience it serves many people, especially those who are unable to take off of work for visits, aren’t located close to their doctor’s office, or have other responsibilities that make them unable to fit in-person visits into their schedules. Unfortunately, it is unknown if Medicare will cover telehealth for all of 2025. Currently, Medicare will cover most telehealth services until March 31, 2025, and after April 1, 2025, you must be located in a rural office or medical facility for most telehealth services to be covered [4]. Future legislation will determine whether Medicare will revert to covering most telehealth services from any location.

Key Telehealth Services Covered by Medicare in 2025

Medicare currently covers the following telehealth services:

Virtual primary care visits [5]
Mental health services [6]
Monthly End-Stage Renal Disease (ESRD) visits for home dialysis [4]
Acute stroke diagnosis, treatment, and evaluation [4]

Telehealth Accessibility and Infrastructure

To ensure that telehealth can be accessed equally by all beneficiaries, a few guidelines must be set in place:

Broadband expansion initiatives for rural beneficiaries: Fast-speed internet access must be available to beneficiaries in rural areas for them to properly access the benefits of telehealth services. Otherwise, those in rural areas may have to travel long distances for their healthcare services [7].
User-friendly platforms for seniors: Telehealth platforms should be designed with individuals with limited technology knowledge and ability in mind. Seniors, who may be less tech-savvy, may struggle with virtual visits if the sites aren’t accessible and easy to navigate.
Integration with existing Medicare systems: Embedding telehealth services into existing Medicare systems ensures a seamless transition for billing, coordinating care, and keeping track of services.

Artificial Intelligence: The Engine Driving Primary Care Innovation

Healthcare providers use a handful of AI platforms to make healthcare more accessible, efficient, and accurate. AI platforms are supporting patients through diagnosis all the way through treatment in many ways. The possibilities with AI are endless, but it is currently being used to help diagnose conditions, develop patient treatment plans, and support clinicians in medical decision-making [8].

For example, AI algorithms have the impressive ability to analyze large sets of medical data and images, assisting clinicians in spotting diseases so they can move on to treating them quicker [9]. Additionally, AI can also be used to predict individual patient health risks by scanning their medical history and information on their current diagnoses, and create an effective treatment plan based on this data [9].

AI-Powered Triage and Risk Assessment

Virtual health assistants for initial patient screening: Having a virtual health assistant is like having access to a medical professional at your fingertips. They can help screen patients through simple questions about health concerns and history to identify potential health issues early or practice preventative care. Screening virtually, whenever possible, saves individuals a trip to the doctor’s office.

Predictive analytics for early disease detection: Predictive analytics examine an individual’s health history and anticipate what health issues may arise in the future [10]. Using data, predictive analytics and machine learning models may detect even the earliest signs of diabetes or heart conditions, which can mitigate more severe and life-altering issues in the future [11].

AI-guided decision support for providers: AI can help organize patient health data and provide evidence-based recommendations for diagnosis and treatments, which help doctors create the best plans for their patients. These platforms work by analyzing medical knowledge combined with individual patient data and universal best practices to optimize care and reduce the chance of errors in diagnosis or treatment [12].

Enhancing Chronic Disease Management with AI

Nowadays, chronic disease management is made simpler through the use of wearable devices, AI-driven medication management, and personalized treatment plans. Everywhere you turn, people are wearing smartwatches to track their step count and heart rate. But, smartwatches and wearable devices can do more than this—they can help detect health issues like high/low blood pressure, heart disease, and even sleep disorders [13].

Other AI-driven technologies, like medication management systems, can help individuals follow their prescriptions by receiving reminders to take their medications at the right time [14]. This can be especially helpful for seniors struggling with memory or cognition issues. AI can also provide personalized lifestyle and treatment tips, helping individuals make informed decisions about their diet, exercise routine, medications, and supplements, ultimately helping them control their health and well-being.

The Synergy of AI and Telehealth in Medicare Services

The shift toward using AI and telehealth in Medicare is quickly evolving this landscape, increasing efficiencies every day. Real-time language translation allows healthcare providers to communicate with all patients, regardless of language barriers [15]. This ensures that all patients have equal access to care and treatment instructions they can easily grasp and understand. AI also assists in documentation and coding to help simplify administrative tasks, like paperwork [16]. This means that healthcare providers can spend less time on organizing files and more time treating their patients.

Navigating the New Primary Care Landscape: A Patient’s Guide

Medicare offers a bunch of telehealth services, making it easier than ever for patients to access care from the comfort of their homes. Telehealth services include virtual visits with primary care providers, mental health services, and some qualifying specialist consultations. Coverage may depend on location, type of service, and the Medicare enrollment of the provider, so it is important to check coverage with your provider.

Once you confirm coverage, prepare for your telehealth primary care visit by checking that your internet connection is stable, that your device’s camera and microphone work, and that you are situated in a private, comfortable space. Before your appointment time, make a list of questions or topics you’d like to discuss with your provider.

Challenges and Considerations in the AI-Telehealth Era

It’s completely normal to have some concerns about AI, especially if you are new to it. For one, it is crucial for healthcare providers to initiate cybersecurity measures to protect patient information at all costs and to comply with HIPAA regulations. Patients should be educated on how AI will use and protect their data.

It’s also important to acknowledge that not everyone has access to the technology essential to participating in telehealth visits or AI-based care. If you don’t have high-speed internet, wearable devices, or a smartphone, you may be at a disadvantage. Healthcare systems must mitigate this gap by investing in programs that fight for equity in access to care for all and efforts to support those with limited tech literacy.

The Impact on Healthcare Providers

A learning curve comes with any major advancement in the healthcare field, including the use of AI. This means that healthcare providers will need to devote some time to AI-based care training and accumulating new skills. They must get used to using AI technology daily, as it is being used to increase efficiency on many tedious tasks. This means that instead of taking time out of each day for scheduling, intake forms, and documentation, they can pass these tasks onto AI and use their time elsewhere, like personalized care.

Medicare Policy Updates Supporting AI and Telehealth Integration

In 2025, to align with the rise of AI-driven technology in the digital world, Medicare updated policies so that they include more support for telehealth and AI-based healthcare services. Some of these updates include coverage for virtual visits [6], AI-assisted care [17], and accessible and high-quality remote healthcare. Medicare aims to assess the quality of virtual healthcare services by evaluating the use of AI in remote care settings to ensure that patients are receiving the same, high-quality care—whether they are in the office or at home [18].

Preparing for Your 2025 Medicare Enrollment: Telehealth Considerations

We understand that updates to Medicare AI-based care and telehealth in 2025 are plentiful and a bit overwhelming. Here are answers to some frequently asked questions you may still have about the process that you can consider before enrollment:

Does Medicare cover telehealth services in 2025?

Yes, Medicare will still cover telehealth services in 2025. This includes physician visits, mental health services, and certain clinics [6]. Please be sure to check with your provider about the specific services they offer through telehealth.

How can I stay informed about Medicare’s telehealth options?

Because there are frequent updates to Medicare coverage over the years, it is important to stay updated on the most recent policies. In 2025, some telehealth options may have different reimbursement policies, and the types of care may differ from prior years. By keeping tabs on Medicare’s official website and the Centers for Medicare and Medicaid Services (CMS) website, you can stay informed and get the latest updates on telehealth policies.

Conclusion: Embracing the Digital Transformation of Primary Care

With all the changes and advancements in the technology field affecting healthcare, it’s normal to feel overwhelmed and a bit confused. Hopefully, this blog cleared up some confusion on emerging technology, like AI and telehealth, and its relationship with Medicare and healthcare in general. The technological world is constantly evolving, and with these changes come improvements to efficiencies, access, and research—all benefiting your wellness. Get involved in these advancements and don’t be afraid to ask questions to stay informed about your healthcare journey!

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What the 2025 Medicare Part D $2,000 Cap Means for Beneficiaries

Did you know that Medicare will undergo major changes in 2025? If this news comes as a surprise, we are here to help ease any anxiety by outlining the changes and explaining what they mean for your coverage. Medicare Part D is a voluntary section of Medicare that provides financial assistance and coverage for many prescription medications. Although enrolling in Medicare Part D is completely optional, it may be recommended for seniors who are taking multiple prescription medications for chronic conditions and need financial assistance. Keep reading to learn about the changes coming to Medicare Part D in 2025, including a new out-of-pocket cap, updated payment plans, and changes to Medicare responsibilities.

The $2,000 Out-of-Pocket Cap: A Game-Changer for Beneficiaries

The Inflation Reduction Act was designed to reduce the high and burdening costs of prescription medications for millions of people on Medicare [1]. Due to the Inflation Reduction Act, Medicare Part D implemented a new out-of-pocket cap of $2,000 per year [2]. This means that once beneficiaries reach this cap, they will no longer have to pay for prescription medications out of pocket.

This is a huge positive change compared to the out-of-pocket cap for Medicare Part D just last year. In 2024, the cap on total out-of-pocket costs for prescription drugs for those taking generic and brand-name was $8,000—which means that most individuals were contributing about $3,300 toward brand-name drugs and $3,400-$3,800 in generic drugs [3].

The new 2025 out-of-pocket cap benefits many different types of beneficiaries. First, it benefits those who have multiple chronic conditions or take expensive medications, like cancer treatments, by reducing their financial burden [4]. Second, it aids those who make low-to-moderate incomes and/or seniors on fixed incomes who may have struggled to reach the point of financial relief due to the previously high cap.

Breaking Down the 2025 Medicare Part D Structure

The Three Phases of Coverage

In 2025, Medicare will simplify its coverage into three basic phases [5]:

Annual Deductible: In this phase, beneficiaries pay for their prescription drug costs until they reach their deductible. Once they hit the deductible, they move to the next phase, in which plan sponsors will cover the remaining costs of medications.
Initial Coverage: In this phase, beneficiaries will continue to pay fixed copayments while Medicare and insurance plan sponsors cover the rest of the costs. This makes things much more affordable for beneficiaries, who often got caught in the “donut hole” of high costs in the past. Once beneficiaries reach the $2,000 cap, they move onto the next phase.
Catastrophic Coverage: In this phase, beneficiaries only need to pay small copayments the rest of the year, while Medicare covers the rest of the costs.

Cost-Sharing Between Stakeholders

Costs are shared among beneficiaries, plan sponsors, and Medicare in different ways depending on the phase.

In the Annual Deductible phase, beneficiaries pay a deductible of $590 at most [6]. Plan sponsors and Medicare do not start contributing during this phase since the deductible has not yet been reached [5].

In the Initial Coverage stage, the beneficiary has met their deductible and will now contribute through copayments and coinsurance for their prescription medications. Plan sponsors pay a large portion of the cost, while Medicare does not contribute. Once the beneficiary reaches the $2,000 cap, they move into the final phase [5].

In the final phase, Catastrophic Coverage, beneficiaries pay small copayments for the rest of the year. Medicare takes care of most costs at this stage, while plan sponsors cover whatever is not covered by Medicare and copayments [5].

Beyond the Cap: Other Significant Changes to Medicare Part D

Wondering about the Medicare “donut hole” everyone is talking about? This is understandable. The donut hole is a metaphor used to describe the gap in Medicare Part D coverage where beneficiaries had to pay a large portion of prescription medication costs after reaching their spending limit but before they qualified for catastrophic coverage. Thankfully, the Medicare Part D coverage eliminates the donut hole, putting you in the Catastrophic coverage phase as soon as your costs reach the $2,000 cap [7].

This leads to the introduction of the Medicare Prescription Payment Plan, or MP3, which spreads out the out-of-pocket costs by implementing a monthly payment plan. Anyone who opts for Medicare Part D can use M3P and avoid paying all at once [8].

Impact on Medicare Advantage Plans in 2025

You may be wondering how all of these changes may affect Medicare Advantage plans in 2025. Most Medicare Advantage plans include Part D prescription drug coverage [9]. This means that the changes to Part D apply to beneficiaries on a Medicare Advantage plan that includes Part D. If you are torn about whether to choose a Medicare Advantage plan or go with Original Medicare, it is a good idea to research each option thoroughly based on your needs. Medicare Advantage plans tend to be beneficial for those who are looking for more comprehensive benefits, while Original Medicare tends to be more beneficial for those who want more freedom to choose any doctors who take Medicare (including those outside of the specific plan network [10]. However, there is not a one-size-fits-all answer to whether you should choose Medicare Advantage or Original Medicare—it depends on your specific needs and preferences.

Medicare Part B in 2025: Related Changes and Considerations

The 2025 Medicare Part B premium cost for physician visits and outpatient care increased slightly since last year and is set at $185 per month [11]. The increase to Part B is separate from the change to the out-of-pocket cap in Part D.

Navigating Your Medicare Choices in Light of 2025 Changes

To holistically and conveniently reassess your 2025 Medicare coverage in light of these changes, follow these steps:

Review your current plan. Look at your current coverage and how well it meets your healthcare needs. You can use the Medicare Plan Finder to compare your current plans with any other plans you may be considering. Complete this step between October 15 and December 7, 2025, as this is the Medicare Open Enrollment Period when you can make coverage changes [12].
Make changes to your coverage by December 7, 2025—the end of the open enrollment period. If you wish to switch from one plan to another, you must do so by this date.

Financial Planning for the 2025 Medicare Landscape

To budget for out-of-pocket costs according to the 2025 Medicare updates, it is important that you review your prescription drug costs. Make a list of your current medications and check their costs under your plan so you are aware of when you will reach the $2,000 cap. This will help you budget your spending before you reach the cap. You should also consider Medicare Advantage plans if you need more than just prescription drug coverage, and these plans often bundle additional benefits with prescription drug coverage, like dental, vision, and wellness services [13].

Frequently Asked Questions About 2025 Medicare Part D Changes

Common Concerns and Misconceptions

Question: Will the new $2,000 cap mean that I’ll never have to pay for prescription medications again?

Answer: No. After you reach the $2,000 cap, your out-of-pocket spending for covered prescription medications will be covered, but you will still have to pay small copayments for the rest of the year. If you take medications that are not covered under Medicare Part D or Medicare Advantage, you may still need to pay for those fully.

Impact on Specific Medications and Treatments

Question: How will the changes to Medicare Part D affect the cost of my medications?

Answer: This depends on which Part D plan you choose. The new $2,000 cap will help reduce your out-of-pocket spending for covered prescription medications, but it is important to check if all the medications you need are covered. Some medications may become more affordable due to this change, but some may not.

Conclusion: Embracing the Future of Medicare Part D

With this overview, you should now feel ready to navigate the changes made to Medicare Part D in 2025. Remember to plan for the future proactively and mark the annual enrollment period on your calendar in case you wish to make changes to your plan. Stay informed, and don’t be afraid to ask questions!

Sources

Medicare Plan Finder: https://www.medicare.gov/plan-compare/#/?year=2025&lang=en

Complete Guide to Medicare Coverage for Ozempic and Diabetes Supplies

If you’ve been prescribed Ozempic to treat your diabetes, you likely know that prices can be costly. Government-funded programs like Medicare help cover the costs of many prescription medications, but whether it covers Ozempic is a bit tricky. This blog post will cover an overview of Ozempic and its Medicare coverage explanation, as well as some other diabetes treatment tools that Medicare helps cover.

Overview of Ozempic

What is Ozempic?

Ozempic (semaglutide) is an FDA-approved injectable prescription medication for the improvement of blood sugar levels of adults with type 2 diabetes [1]. Its active ingredient, semaglutide, helps the body respond to rises in blood sugar and makes the pancreas produce more insulin at these times. Simultaneously, it prevents your liver from releasing too much sugar [2]. Although this drug is FDA-approved and has helped many individuals with their type 2 diabetes, it also has several limitations. Serious side effects and allergic reactions may occur, so you must first consult with your healthcare provider to determine if Ozempic is right for you.

Ozempic and Pre-Diabetes

As previously mentioned, Ozempic is approved for type 2 diabetes. However, there is an “off-label” use of Ozempic for prediabetes, or elevated blood sugar levels that haven’t yet met the threshold of type 2 diabetes [3]. “Off-label” refers to a medication being prescribed for a condition the FDA has not formally approved it for [4]. Although it is typically not recommended to prescribe a drug to treat a condition other than what it is formally approved for, some physicians have prescribed Ozempic for prediabetes. This is because of current research that has found that other glucagon-like peptide-1 (GLP-1) medications helped people with prediabetes lower their blood sugar levels enough to prevent type 2 diabetes [5].

Despite this research, the FDA raises concerns about prescribing “off-label” GLP-1 medications for prediabetes. This is because using drugs unapproved for specific uses means that these drugs have not been carefully reviewed for efficacy and safety, which can lead to significant risks [6].

Medicare Coverage for Ozempic

Medicare Part D Coverage

Medicare Part D plans cover the costs of many prescription medications, and for 94% of plans, Ozempic is included. However, the amount of coverage you receive depends on which coverage stage you are in. If you are still in the deductible stage, meaning you haven’t yet met your deductible minimum payment, Ozempic will likely cost more than if you are in the post-deductible stage [7]. Additionally, Ozempic is often classified as a Tier 3 or Tier 4 medication, which means that it is a brand-name drug and often has a higher copayment than Tier 1 and 2 drugs [8]. Tier classification and copayment will vary based on a plan’s specific formulary.

Coverage Restrictions

It is important to note that Medicare coverage of Ozempic comes with a few restrictions. First, at this point, Medicare covers Ozempic for its FDA-approved purpose only: the management of type 2 diabetes. Medicare is not permitted by law to cover drugs for weight loss [9], though this may change in the future depending on policy changes. Additionally, Medicare requires most drugs to have prior authorization, meaning that your prescriber must contact your insurance plan and confirm that the prescription is necessary before you can receive coverage [10].

Medicare Diabetic Testing Guidelines

Comprehensive Diabetes Monitoring

Blood sugar monitoring is crucial for the management of diabetes. If you were advised to take insulin for your diabetes, your doctor will likely also recommend a continuous glucose monitor or CGM. This device gives you real-time updates about your blood sugar levels [11]. You should typically test and record your blood sugar levels at multiple times of the day—before meals and before you go to sleep [12]. You may need to test your levels extra when you are sick or have changes in your diet or exercise routine. Medicare Part B covers certain diagnostic procedures for type 2 diabetes. If your doctor deems you “at risk” for diabetes and recommends that you get a blood glucose laboratory screening test, your Medicare plan can help cover these tests based on your plan’s Part B coverage limits. It is important that you listen to your doctor’s recommendations for screening tests—these can help prevent diabetes before it’s formally diagnosed, and keep you up to date on your current health needs.

Preventive Measures [14]

Medicare cares about preventing diabetes in every way possible. This is why they put forth the Medicare Diabetes Prevention Program (MDPP), which is a health behavior change program designed to help you make the lifestyle changes necessary to reduce your chances of developing diabetes. In this program, you’ll learn how to make life-altering changes to your diet and exercise patterns, tips for controlling your weight, a designated coach to help you through these changes, and a group of people who are going through something similar who you can turn to for support. The program begins with 16-week sessions on these topics and also includes 6-month follow-up sessions to track your progress. According to the Centers for Disease Control and Prevention (CDC), these programs can help reduce your risk of developing type 2 diabetes by over 70% [15].

Diabetic Supplies Covered by Medicare Part B

Comprehensive Supply Coverage [16]

Medicare Part B covers blood glucose self-testing equipment (such as a CGM), insulin pumps as well as the insulin itself, and therapeutic shoes and shoe inserts. If you use insulin, Medicare will cover up to 300 test strips and 300 lancets every 3 months, and 1 lancet device every 6 months. If you do not use insulin, Medicare will cover up to 100 test strips and 100 lancets every 3 months, as well as 1 lancet device every 6 months. Blood glucose self-testing equipment will only be covered after the patient receives a prescription from their doctor claiming this is necessary. These supplies will not automatically be sent to the patient—the patient must first request them. It’s important to note that beneficiaries may have additional coverage and programs based on their specific plan.

Continuous Glucose Monitoring (CGM) Coverage

Medicare CGM Guidelines [17]

Many people with diabetes must regularly monitor their blood sugar levels with a CGM, or continuous glucose monitoring, device. The cost of this device can get pricey, which is why many benefit from Medicare coverage of CGM devices. Medicare helps cover the cost of CGM devices under a few conditions:

You must be diagnosed with diabetes mellitus.
You must take insulin or have a history of issues with low blood sugar
You must receive a prescription for diabetes testing supplies and guidelines on how often you should test your blood sugar levels
You must be trained on how to use a CGM device. If you have a caregiver, your caregiver must be trained on how to use this device.
You must make regular appointments to visit your doctor in person or have Medicare-approved telehealth visits.

Additionally, not all CGM devices are approved to be covered by Medicare. The particular type of CGM device must be approved by your plan and the FDA to be covered [18].

Impact on Patient Care

Doctors often recommend continuous monitoring devices for diabetes for a reason—they help keep patients in the know regarding their blood sugar levels. These real-time updates can help patients make smart decisions about their diet, exercise patterns, and medications. Using a CGM device in combination with Ozempic treatment can help patients understand if their treatment is working properly, and if it may be causing any complications or side effects [19]. Above all, they keep patients in the know and aware of what is happening in their bodies, empowering them to take the front seat in managing their health.

Finding Medicare Suppliers for Diabetic Supplies

Navigating Supplier Networks [20]

If you prefer to order your medical equipment directly from a supplier instead of from the pharmacy, this can be done as long as the supplier is Medicare-approved or in your plans network. You’ll need a prescription from your doctor to order these supplies. To discover which medical equipment providers are approved by Medicare, visit the Supplier Directory, or your specific plan’s provider directory

Insurance Considerations

Diabetes medication and management tools may differ in coverage depending on your type of insurance. Research your specific plan to learn more about diabetes coverage.

Financial Considerations

Out-of-Pocket Costs

Medicare caps the monthly cost of insulin at $35 for those who qualify for Medicare coverage of diabetes management tools and medications [22]. This means that you will never pay more than $35 per month for covered and approved insulin, and you will not have to pay a deductible if your insulin is covered under the Medicare program.

Savings Opportunities

If you are looking to save money on diabetes management tools and medication, there are options out there for you. Unfortunately, Medicare cannot use manufacturer coupons to reduce the cost of diabetes medications [24], but there are other ways to save money. There are several state based and federal programs which help Medicare beneficiaries with prescription savings. Patients should research patient assistance programs to see if they qualify. These programs can end up saving patients a great deal of money on monthly prescription costs. Additionally, if you receive a 90-day supply of treatment, you’ll only pay $35 per month, meaning that your out-of-pocket maximum will be at most $105.

Potential Challenges and Solutions

Coverage Limitations

Coverage limitations and plan formularies may create roadblocks in your treatment journey. For an unlisted drug to be covered by Medicare, your doctor may need to provide a strong rationale for why this off-label drug is necessary, as opposed to other FDA-approved drugs, for it to be potentially covered. Navigating insurance complexities can feel confusing and isolating, which is why you shouldreach out to professionals for help in this space.

Alternative Approaches

Managing your diabetes using the interventions recommended by your doctor is highly recommended to ensure your health is maintained. However, there are ways to manage your diabetes without medication or supplies. Lifestyle interventions, like eating a healthier and more nutritious diet, exercising regularly, and getting enough quality sleep can help manage your diabetes [24]. It is important to still consult with your healthcare provider regularly while adjusting your lifestyle so you can check if these lifestyle changes are making a positive impact on your health.

Conclusion

As long as Ozempic has been prescribed by your doctor for the treatment of type 2 diabetes, Medicare currently covers the cost for the majority of plans. It is crucial that you closely follow your doctor’s instructions for taking care of your diabetes—everyone’s treatment journey is different. With ongoing research in diabetes management, we may see more evidence emerge about the effectiveness of certain medications. Contact Greater Good Health today with any questions about diabetes management, Medicare coverage, and alternative treatment options.