It’s Time to Assess Your Part D Plan for 2025!

Welcome to Part 4 of our Medicare Series. In Part 1 we covered the parts of Medicare, when you qualify for it, and how you enroll. In Part 2, we covered the importance of reviewing your plan each year. In Part 3 we looked at the differences between original Medicare and Medicare Advantage. In this installment we look at Medicare Part D — Medicare Drug Coverage.

As a result of the Inflation Reduction Act of 2022, there are going to be some big changes in the Medicare drug program for 2025. The Act now imposes a $2,000 cap on total out-of-pocket spending for drugs covered by your plan. This will be a huge benefit for those who take expensive drugs for serious conditions, such as cancer or multiple sclerosis. This change adds on to other changes required by the Act, such as a $35 monthly cap on the price of insulin for diabetic patients, and free vaccines and financial assistance for low-income seniors.

Open enrollment for Medicare coverage, including Part D drug coverage runs until December 7, so act now!

Considerations – Original Medicare
It’s time to reevaluate your stand-alone Part D prescription plan for next year. While the changes required by the Inflation Reduction Act are positive on the whole, they have in some cases prompted insurers to raise premiums for stand-alone plans. Companies can raise premiums by as much as $35 per month. In addition to premiums, enrollees will pay a maximum deductible up to $590 and then pay part of drug costs up to the $2,000 ceiling. Reminder, however, that the $2,000 cap on medications ONLY applies to drugs covered by your plan.

Considerations – Medicare Advantage
Medicare Advantage plans often include Part D, as well as dental and vision plans, or other benefits. There are likely to be big changes in Medicare Advantage in 2025 — next year 60% of enrollees in plans that include drug coverage will pay a medication deductible, up from 21% in 2024. The deductible in 2025 for enrollees who receive low-income subsidies will be four times higher than in 2024 ($225 vs. $59).

Tips for Choosing Coverage: Whichever Medicare you have, this is the time to explore your options. Here are the best ways to do so:
– Check the formulary (list of drugs offered) by your plan to ensure that the medication you require is on the plan.
– Review the annual notice from your current plan – it includes information on your premium for 2025 as well as any changes to your drug coverage.
– Contact the New York State Health Insurance Information, Counseling and Assistance program for help by calling 1-800-701-0501, or visiting their website or Facebook page.
– Visit the government’s Medicare Plan Compare site, which will show you not only premiums, but projected total annual costs including deductibles and your cost-sharing after premiums.
– Remember, you have options. If you need a medication not included in your plan’s formulary, you can file an appeal if you have a medical reason.

Reminder – You only have about a month left of open enrollment (12/7) so don’t delay in reexamining your plan!

Stay tuned as we cover more Medicare topics in upcoming issues of this blog!

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The information provided herein does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available here are for general informational purposes only.