Going Deeper: Prescription Drug Coverage Changes for 2025
Attention: Medicare Beneficiaries
This year’s Annual Enrollment is going to be the busiest since The Modernization of Medicare Act that began in 2006, when Prescription Drug Coverage was enacted, and Medicare Advantage was expanded. The Inflation Reduction Act (IRA) of 2022 has introduced more changes to Medicare than at any other time since then! You will likely see an impact on your premium and plan benefits, resulting from the new rules.
The changes IRA has made to Prescription Drug Coverage (Part D) may cause premiums to be higher, drug formularies to be slimmer, and utilization measures such as prior authorizations and step therapy for certain medications to be more common. Your cost share for prescriptions, meaning deductibles, copays, and coinsurance may also be higher.
Annual enrollment begins each year on October 15th and ends on December 7th. This year your annual notice of change will contain information regarding the new rules and changes to drug coverage in 2025.
How do the changes affect you?
If you are a Medicare beneficiary who typically pays more than $2000 in the year for your covered prescriptions- you will not pay more than $2,000 for all your covered prescriptions in 2025! However, if you are a Medicare beneficiary who pays less than $2,000 for covered prescriptions, you may pay more for your prescriptions in 2025 due to fewer plan choices and higher cost share on some plans up to the $2000 limit. As part of the new law, there is a new program being implemented called the Medicare Prescription Payment Plan (M3P) that is intended to help a Medicare beneficiary “smooth” the cost of medication throughout the year rather than having to pay all costs upfront at the pharmacy. What to do:
Carefully read and assess the changes to your Medicare plan in 2025. You will receive your Annual Notice of Change (ANOC) letter in September from your current insurance carrier. If the changes to your plan are not acceptable to you, please call your broker as early as possible to make sure you can get the help you need within the allotted 54 days from 10/15-12/7. Come to the Senior Benefit Advantage educational meetings at the following locations:
Coshocton Village Inn and Suites:
· Wednesday 9/18 at 10 am, and 2pm
· Wednesday 9/25 at 10 am, and 2pm
Coshocton County District Library:
· Monday 10/7 at 10:30 am
Our Mission at Senior Benefit Advantage:
At Senior Benefit Advantage, we strive to be a source of information to our clients and our community regarding changes to Medicare and the impact those changes may have on you. It is our mission to be a valued resource to our community as an agency specializing exclusively in Medicare Products and services.
