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Changes in Drug Coverage Coming in 2025 Could Influence Your Choice of Plan

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Medicare open enrollment is just around the corner. On October 15, people with Medicare can opt to join a standalone Part D or Medicare Advantage plan or, if they are already enrolled in a plan, switch plans to one that better suits their needs.

Beneficiaries should be aware of major changes coming in 2025, as some of the changes may affect what plans are best for them.

Part D covered drug costs will be capped at $2000 out-of-pocket. Once enrollees hit that number, they will have no copays or coinsurance for covered drugs for the rest of the year. The out-of-pocket maximum does not include premiums, so those shopping for a plan must be alert to the combination of drug costs and premiums.

In 2025, people will also be able to elect a payment plan managed by their Part D plan to spread the cost of their copays or coinsurance over the year. This will help people with high drug costs in the early months of the year manage their budgets.

These payment plans will not reduce the total amount an individual spends on drugs. Instead, they will help spread out costs across the year. Importantly, payments can still vary from month to month, and some people may not benefit from joining a payment plan.

If you struggle to afford your bills, consider programs like the Low-Income Subsidy (LIS or “Extra Help”) or a Medicare Savings Program first. These programs can help people afford their care.

These big changes build on other changes in the Inflation Reduction Act of 2022 (IRA), including insulin costs capped at $35 per fill, more access to vaccines, expansion of Extra Help, which assists with Part D premiums and costs, and the drug price negotiation program.

Read more about the IRA’s changes.

Learn about the Medicare Prescription Payment Plan, which can help spread the cost of drugs yearly.

Policy Issues: Prescription Drugs
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