Medicare 2025

 

1. The maximum out of pocket costs for an individuals prescription drugs will be $2,000.

 

2. The prescription drug plan company's share of the cost of the drugs will go up to 60-65%. This is up from 2024 cost share of 25%. Any company offering stand alone Part D and Medicare Advantage plans that include Part D prescription drug benefit will be affected.

 

The $2,000 maximum will help a lot of individuals that have been paying as much as $8,000. 

 

The added cost share for the companies will most likely cause some drastic changes in premiums, variety of drugs offered on each plan, as well as higher co-pays or fewer additional benefits for Medicare Advantage plans. Also, some of the carriers may require higher cost share until the $2,000 maximum is met.

 

We have already been informed of two carriers pulling out of Medicare Advantage and Part D coverage effective 2025.

 

If you have a Medicare Advantage plan and your carrier closes your plan, you are entitled to the following:

 

1. A guaranteed issue for a Medicare Supplement with no underwriting.

 

2. A Special Election Period (SEP) which gives you 60 days from the notice to choose a new Medicare Advantage plan. This will extend your enrollment period to the end of the year, not December 7th. This will be beneficial in what is sure to be a crazy Medicare season due to these changes.

 

Keep all correspondence from your carrier going forward including your Annual Notification of Change (ANOC) that usually is sent out in September. 

 

These changes will not affect your 2024 coverage, but you need to be aware that even if your plan remains for 2025, there might possibly be some critical changes.

 

You will still have OEP to change Medicare Advantage Prescription Drug plans from January 1st thru March 31st 2025. So, there is no need to panic, but be aware there may be changes and stay tuned.