As we age, our health care needs often increase, making selecting the right Medicare coverage a key part of maintaining our health and well-being. One area that is critical for you to review is Medicare’s prescription drug coverage, which helps cover the cost of the medications you need. Starting in 2025, major changes are coming to Medicare’s prescription drug coverage to help make medications cost less and easier to get. Below, I am going to discuss what these changes can mean for you and how to prepare for them.
- Out-of-Pocket Spending Cap
One of the biggest changes coming next year is the introduction of an out-of-pocket spending cap for Medicare Part D, which covers prescription drugs. Currently, there is no cap on how much you might have to spend out of pocket for your medications each year, and this can lead to high costs, especially if you have chronic conditions requiring expensive or daily medications. Starting next year, Medicare Part D will include a cap on out-of-pocket expenses set at $2,000 per year. This means once you have spent $2,000 on prescription drugs within a calendar year, Medicare will cover the rest of the costs for your medication until the end of that calendar year.
- Expanded Eligibility for Extra Help Program
Another important change is the expansion of the Extra Help program, which helps individuals with limited income and resources pay for their Medicare prescription drug coverage, including premiums, deductibles and co-pays. Starting in 2025, the threshold for eligibility will be raised allowing more people to be eligible for assistance. If you qualify, this program could reduce your prescription drug costs.
- Reduction in Drug Prices
The cost of prescription drugs has been a growing concern for many over the last few years. In response, new measures are being introduced to help lower drug prices including having Medicare begin negotiating the prices of certain high-cost medications directly with pharmaceutical companies. This new process is expected to result in lower prices for some of the most expensive drugs on the market with the savings being passed on to you in the form of lower out-of-pocket costs.
- Expanded Access to Vaccines
Another positive change coming in 2025 is expanded access to vaccines under Medicare Part D. Many vaccines will be covered at no cost to you, including those recommended by the Advisory Committee on Immunization Practices (ACIP) like the shingles vaccine, which can be costly if not covered by your insurance.
How to prepare for these changes
While these changes are designed to make prescription drug coverage more affordable, it is important to stay informed and prepared. Here are some steps you can take to be prepared for these changes:
- Review Your Current Plan: Take time to review your current Medicare Part D plan. Compare it with the new options that will be available in 2025 to see if switching plans could save you money.
- Check Your Eligibility for Extra Help: With expanded eligibility for the Low-Income Subsidy program, you may now qualify for assistance. Even if you did not qualify before, it’s worth checking again for 2025.
- Talk to Your Doctor or Advanced Practice Provider*: Discuss any expensive medications you’re taking with them so they can help you understand how these new changes might impact the cost of your medications and explore alternatives if necessary.
- Stay Informed: Keep an eye out for updates from Medicare and your plan provider. Understanding these changes and how they affect your coverage can help you make the best decisions for your health and finances in 2025.
The changes to Medicare prescription coverage in 2025 are designed to make medications more affordable and accessible, particularly for those with high drug costs. By staying informed and proactive, you can make sure you are getting the most out of your Medicare coverage while protecting your health in the years to come.
If you are a Village Medical™ patient and need help navigating Medicare’s drug coverage, please click here for more information.
Medicare's Annual Enrollment Period (AEP) is Oct. 15 – Dec. 7.
*An advanced practice provider includes a nurse practitioner or physician assistant.