3 minute read
What's New with Medicare Part D this Year?
hanson insurance | emily hanson
Sixteen local brokers, specializing in Medicare, and ready to assist with all your health insurance needs.
The Inflation Reduction Act is generating prescription concerns for many Medicare beneficiaries in 2025. We knew the changes — like higher premiums and drug deductibles — would bring new challenges but we’ve felt optimistic that the low $2,000 maximum out of pocket for medications would be worth it. For some, it has been! I’m seeing clients save thousands of dollars in just one month!
More often though, I’m seeing people get frustrated when they go to the pharmacy for their first prescription, and they are faced with a much higher bill than they were used to in 2024. Following are two concerns I’ve heard and the answers to them.
Q. MY MEDICATION WAS ONLY $11/MONTH ON MY PLAN LAST YEAR, WHY IS IT $200/MONTH THIS YEAR?
A. All Medicare plans that cover prescription medications change their structure every year. In 2025 we have a maximum medication spend per person of $2,000 (last year was $8,000). The plan you had last year was structured with an $11/mo copay for a brand name medication and this year that same plan charges 25 percent of the retail price of that medication. This is a significant change. Be sure to read the plan Summary of Benefits to make sure you understand how your plan covers your medications. If it doesn’t make sense, call the customer service number on the back of your ID card.
Q. THE PHARMACY SAYS MY MEDICATION ISN’T COVERED BY MY PLAN.
A. Many times when a medication is expensive it simply means that the deductible must be paid before the plan will cover the medication. Sometimes the pharmacy technician will say that your plan isn’t covering it because you have to pay the full retail price. That means you pay the deductible and the next time you fill your prescription it likely will be much less expensive. Resist the urge in 2025 to use GoodRX or a Canadian pharmacy for expensive medications. If you expect to get anywhere near the maximum out-of-pocket limit you need to purchase the medication through your plan. Otherwise, you will pay a lot for your medications all year long, and never reach the maximum amount after which you pay $0 for the rest of the year.
It's not too late to sign up for the M3P program! This program will allow you to pay your full year’s estimated drug cost in equal monthly payments. This keeps you from having to pay a huge chunk at the pharmacy early in the year. Call your insurance company and ask if it is a good idea for you and make sure to sign up at least 24 hours before you head to the pharmacy.
Please remember that just because your plan was one way last year, it won’t necessarily be the same this year. Seek out a local broker if you need additional assistance with cost saving tricks. You don’t have to figure it out alone!
We do not offer every plan available in clients’ area. Currently we represent 13 organizations which offer 92 plans in your area. Please visit Medicare.gov or contact 1-800-MEDICARE or your local State Health Insurance Program (SHIP) to get information on all of your options. We also offer many top rated Medicare Supplement organizations.
