10/06/2024
Most sweeping changes to Medicare in all my years!
More than ever, it is going to be critical we review doctor networks, prescriptions, and other factors that go into selecting your 2025 plan!
The Inflation Reduction Act has eliminated the “donut hole” for prescription drug cost. If you don’t know what that is…feel blessed!
For the first time, there will be an annual max-out-of-pocket of $2000 for covered prescriptions—It may be easier to think of it as a yearly cap of $2,000. If you have spent over $2,000 this year at the pharmacy for your covered prescription drugs, this new cap protects from going over $2,000 in 2025.
If you take zero or maybe two or three generic prescriptions, then this may not impact you directly. On the other hand, if you are on name brand or specialized prescriptions, you have likely been forced to shell out hundreds of dollars meeting deductibles and covering your costs. This may be a welcoming change. Keep in mind, the plan premium does NOT count towards the $2,000 cap.
In addition to the new cap, there will be an option to enroll into Medicare Prescription Payment Plan (referred to as M3P). It is not feasible to go over the complicated details here, but in a nutshell, consumers who have a Medicare prescription drug plan can sign up with their plan provider to spread out deductibles and prescription costs over the course of the calendar year. For more information give me a call or go to www.cms.gov and search for Medicare Prescription Payment Plan.
The cap and M3P are Federal changes. In various states and counties there are several plans by several carriers being discontinued. In September, you should have received the Annual Notice of Changes (ANOC) from your provider. This annual notice illustrates your current plan benefits for 2024 side-by-side with 2025 benefits. The 2025 space should indicate if your plan was terminated. It is critical to know this information. If you are unsure, please reach out to me.