The Medicare Annual Enrollment Period begins every year on October 15. This is a terrific opportunity for everyone on Medicare and those preparing to join Medicare to review their options and make informed decisions about what their Medicare insurance coverage will look like for the coming year. This is also the time of year when Medicare Advantage Plans and Medicare Part D Plans notify their members about major changes for the coming year.
In 2025, there will be some particularly important changes to Medicare drug coverage that will affect anyone who has Medicare Part D, or a Medicare Advantage Plan with Part D included. Here is a summary of how Part D coverage will be different in 2025 in contrast to past years:
- There will no longer be a Coverage Gap for Medicare Part D. Many of us call the Coverage Gap the Donut Hole, but whatever we call it, the gap that occurs after a certain amount of claims have been paid during a calendar year will be a thing of the past.
- Replacing the Coverage Gap will be Maximum Out of Pocket. Once a Medicare beneficiary and their Part D plan provider has incurred a total cost maximum of $2,000 for all drugs purchased, they will be covered by their Medicare Part D plan at 100% for the remainder of the year.
- Medicare Part D beneficiaries who are prescribed high-cost specialty drugs will be able to spread the cost of those drugs out over the course of a 12-month period. This means that anyone on a drug that will max them out at the new Maximum Out Of Pocket amount of $2,000 can spread that cost out from January through December each year.
Both new initiatives are working to help alleviate the burden on retirees of paying for high-cost specialty drugs on a fixed income.
However, just like a row of dominoes, there will be domino-effect changes across the board from Medicare Part D and Medicare Advantage Plans that provide drug coverage. The changes will accommodate these new regulations and the business costs of adapting new policies.
This is where all Medicare beneficiaries need to pay close attention to what changes may be coming from their existing Medicare Part D or Medicare Advantage with drug coverage plans. Take extra care this October to fully understand how these new changes affect you and your insurance carrier. Ask yourself: Are these changes something you can work with, or do you need to shop around and compare options?
Regardless of what 2025 will bring, know that we stand ready to help guide you through this process and provide you with the clearest picture of how these new changes will affect you, your bottom line, your overall quality of life or partner with local resources who can assist you.