3. Part D 2025 Changes - How This All Affects You!

For those reaching the $2000 maximum out of pocket because of either high drug usage or having one or more high cost medications they take, the maximum out of pocket limit will definitely help lower their prescription costs.

The insurers are having to take on a higher amount of cost sharing for their Part D Enrollees and if their costs go higher, so will premiums – especially on Stand Alone Prescription Drug Plans. This is despite the Medicare Part D Premium Stabilization Provision of 6%.

Formularies – the list of drugs that are covered under the Part D Plan and what Tier they are covered under will be narrower and will require enrollees to pay more attention to make sure all their medications are covered under the plan.

Medicare currently requires that all Part D Plans must cover at least 2 drugs for every Therapeutic Category (currently there are 21 major categories such as anti-depressants, anesthetics, anti-convulsants, etc.) They often do, but insurers are not required to cover more than 2 medications in each category.

You must check to make sure that all drugs you are currently taking, and also ask your doctor about any suspected medication changes for the coming year, to make sure that they are COVERED under the plan you chose. Remember you can’t make prescription drug plan changes after December 7th for 2025.

Plans will likely be making many changes to their formularies and you may find that VALUE (low cost) plans, and even some standard plans, will have much smaller lists of covered drugs than in previous years!!! If you have a range of drugs at different Tier levels, you may have to move up to the Premium formularies (highest cost plans in terms of premium) to get them covered.

Do not just assume that your current plan will cover those medications or that your current plan will even exist in 2025!

Insurers are tightening their offerings on both Stand Alone Medicare Part D Plans and also on Medicare Advantage plans – and some plans and insurers are leaving the market altogether because of their rising costs.

When an insurer stops offering a plan (drops a plan) they will generally crosswalk you over to the plan that they feel best meets your needs and you may not agree with their choice.

If you call an insurance company, (or they call you), directly to enroll in a Stand Alone Part D Plan or Medicare Advantage Plan they will only give you a choice of the plans they offer for 2025, when another insurer may have a plan that better suits your needs and budget. You have control but so many people, because this is so incredibly confusing, often just go with whatever the insurance company they are dealing with recommends. That is not necessarily wise on your end!

For 2025 there will now be a “Medicare Prescription Payment Plan”

This plan will allow you to go to a pharmacy or use mail order, and not pay for your medications at the time you receive them.

Your insurer now has to offer you the chance to pick up your medications and get a bill, later on, from your insurer for the medications you received – essentially a buy now pay later alternative. This is designed to help you spread the costs of your medications over time, especially if your Part D Plan has a big deductible.