Many people will have questions about the Medicare Changes in 2025. I hope to outline some of them to help understand what is going to happen.
The Donut Hole or Coverage Gap is going away! Currently, in 2024 there is a Coverage Gap and here is how Medicare.gov describes it:
Costs in the coverage gap
Most Medicare drug plans have a coverage gap (also called the "donut hole"). This means there's a temporary limit on what the drug plan will cover for drugs.
Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs. Once you and your plan have spent $5,030 on covered drugs in 2024, you're in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
In 2025 That Coverage Gap is gone and there is a new Cap on the Total cost of medication for seniors. CMS.gov describes it:
A yearly cap ($2,000 in 2025) on out-of-pocket prescription drug costs in Medicare
2. Medicare is negotiating to get you lower drug prices
For the first time, Medicare is able to negotiate directly with manufacturers for the price of certain high-spending brand-name Medicare Part B and Part D drugs that don’t have competition. Prices have been negotiated for the first 10 drugs selected and will be effective in 2026. Medicare.gov
3. Medicare Prescription Payment Plan - this will give those with high-cost prescriptions an option to make payments over the entire year. Not everyone will be a candidate for this plan so click here to see the CMS Fact Sheet on how the plan works and who it would benefits
These are just a few of the major changes. Find more information at CMS Inflation Reduction Act & Medicare and Medicare.gov Prescription Drug Laws
You should all be getting your Annual Notice of Changes (ANOC) from your current Medicare Prescription or Medicare Advantage Plans. Please pay close attention to those letters so you will not have any surprises in the 2025 Plans.
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Medicare Education and a Helping Hand
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