What’s new for beneficiaries: Improved protections on coverage decisions — Medicare Advantage (MA) and Part…
2025 Medicare Drug Changes
It is that time of the year once again… Annual Enrollment Period, or AEP.
As always, my goal is to help you understand how Medicare works and to empower you to make informed decisions about your healthcare.
AEP starts October 1st and plan changes may take place from October 15th through December 7th. Any plan changes will take effect January 1, 2025.
- If you do nothing, your current plan will roll into the new year.
- If your plan is eliminated, you will be auto migrated into a different plan the carrier chooses, unless you take steps to change.
- There could be substantial differences in premiums, benefits, co-payments, or covered drugs.
- Please review your plan for next year.
Key Drug Plan Changes for Medicare in 2025:
Deductible Stage: Increased deductible of $590. You will need to pay this amount before moving into the copayment stage (Initial Coverage Stage).
Initial Coverage Stage: Co-payments or co-insurance will depend on the tier of the medication:
- Tier 1: Preferred Generics
- Tier 2: Non-Preferred Generics
- Tier 3: Preferred Name Brand Drugs
- Tier 4: Non-Preferred Name Brand Drugs
- Tier 5: Specialty Drugs
- Insulin: Capped at $35 for a 30-day supply
Catastrophic Coverage Stage: Once the “True Out Of Pocket” (TROOP) cost reaches $2,000, you will no longer have to pay for covered Part D drugs.
This diagram shows how it will look.
- While the out-of-pocket maximums have been lowered including the removal of the donut hole, I expect some of those costs to be shifted.
- These shifts mean that there could be substantial differences in premiums, copayments, and covered drugs for 2025.
It is important to review your plan for 2025.
