You may have noticed all the TV and other media advertisements that the Medicare annual enrollment period is currently underway and runs from October 15 through December 7. Medicare beneficiaries can make enrollment decisions to change their enrollment effective January 1, 2025.
Major Changes for 2025
There are a couple major changes in 2025 affecting Part D prescription drug plans:
1. $2,000 out-of-pocket spending cap for prescriptions
The $2,000-a-year out-of-pocket limit for prescription medications applies to stand-alone Medicare Part D policies and prescription drug coverage in Medicare Advantage plans.
It’s the first time in the history of the Medicare program that people have a cap on how much they have to pay out of pocket in a calendar year.
The $2,000 cap includes deductibles, copayments and coinsurance for covered drugs. It doesn’t apply to monthly premiums or to drugs a plan doesn’t cover.
2. No more Part D ‘donut hole’ or coverage gap
This change simplifies the way Part D works.
In 2025, Part D plans can have a deductible up to $590. After you pay the deductible, then you pay copayments for your medications until your total out-of-pocket costs reach $2,000. After your total out-of-pocket costs reach $2,000, your Medicare Part D plan will cover the cost of your medications until the end of the calendar year.
Therefore, it may be prudent for Medicare beneficiaries to determine whether a different standalone Part D plan or one bundled with their Medicare Advantage plan may be more cost effective for them in 2025.
Information on all Medicare plans offered by zipcode can be found at medicare.gov.
EBC Offers Medicare 101
EBC offers our employer clients and their Medicare eligible employees and/or spouses a Powerpoint Presentation called Medicare 101. It covers the basics of Medicare such as who is eligible for Medicare, the different parts of Medicare (e.g., Parts A, B, C and D), plan options, when to enroll, and how Medicare works with employer plans. Medicare 101 may be useful for employees approaching age 65, contemplating retirement in the future, or may be interested in enrolling themselves and/or their spouses in Medicare rather than through their employer’s health plan.
In addition, EBC has Medicare certified agents that can help our client’s employees and/or their spouses to determine what Medicare plan is best for them and their budget as well as assist in their enrollment in the plans that they choose.
Although people already enrolled in Medicare can make enrollment changes during the annual enrollment period, October 15 through December 7 with an effective date of January 1, employees currently enrolled in health plans via their employer can enroll in Medicare effective in any month of the year if they are age 65 or older. Enrolling in Medicare may save money for the employee and the employer.
