Major change coming to Medicare Part D in 2025

on Oct 10, 2024

Toni:

I understand that there is a major change to the 2025 Medicare Part D plan with the “Donut Hole” going away. I’m concerned because this year, I entered the donut hole in July and will exit it in November. This month’s Part D statement explained that my prescription drug costs have exploded for the remainder of 2024.

If the “Donut Hole” is leaving the Medicare prescription drug plan in 2025, how will this affect me? Toni, please explain in easy-to-understand terms what the changes are to the Medicare Part D prescription drug plan for 2025. Thanks.

--Melodye from Spring, Texas

Melodye:

Since the 2025 Part D plans became available on www.medicare.gov on Oct. 1, the Toni Says Medicare team has reviewed the serious changes to Part D premiums and prescription drug costs. Melodye, I have great news for you: Effective Jan. 1 the Donut Hole is going away!

You were correct that there is a major change to the 2025 Medicare Part D plan. This change helps to make prescription drugs affordable for Americans on Medicare. When Medicare’s famous “Donut Hole” goes away, Melodye, your maximum out-of-pocket for your Part D prescriptions in 2025 will be $2,000. This will be a great relief for many on Medicare!

2025 Medicare Part D costs are:

-- Initial Deductible: $590.

-- Initial Coverage Stage: During the Initial Coverage 5 drug-tier stages, the Part D plan pays its share of the cost of your drugs, and you pay your share of the cost until the maximum amount of $2000 out-of-pocket is met. Then you move to the Catastrophic Coverage stage.

-- 5 Drug-Tiers of Initial Coverage are: Drug Tier 1: preferred generic drugs; Drug Tier 2: generic drugs, Drug Tier 3: preferred brand drugs; Drug Tier 4: non-preferred drugs; Drug Tier 5: specialty drugs. (Drug Tier copays are different depending on which Part D or Medicare Advantage Plan with Part D you have chosen).

-- Donut Hole (Coverage Gap): effective Jan. 1, 2025, Medicare’s Donut Hole/Coverage Gap no longer exists.

-- Catastrophic Coverage: The $0 out of pocket began Jan. 1, 2024. When the beneficiary enters the Catastrophic Coverage stage, Medicare will pick up all cost of the prescriptions, whether brand name or generic, and those with a Medicare Part D plan pay $0.

On Jan. 1 of each year, the process starts all over again with a new Medicare Prescription Drug plan and new initial deductible and maximum initial coverage limit.

The Medicare Prescription Payment Plan is a new payment option beginning Jan.1 ,2025, to help manage your out-of-pocket drug costs by spreading your monthly prescription drug costs throughout the entire year from January through December. For more information about the payment plan, visit www.medicare.gov or call your Medicare Part D plan.

Here are Toni Says Tips to help you find a Part D plan.

1. Visit www.medicare.gov to view 2025 Medicare Part D and Medicare Advantage plans. The website has a tool for helping you narrow your search for new Medicare Advantage and Prescription Drug plans.

2. Talk to your Primary Care and specialty doctors about which brand name drugs can be changed to generics.

3. Get samples from your doctor.

4. Search various prescription drug programs such as GoodRx, Single Care or Amazon for less expensive prescription drug costs. Wal-Mart, Kroger, HEB and Costco also have discount prescription drug plans.

Readers, your prescription drug needs can change with each yearly Medicare Annual Enrollment. Review your options carefully, because with Medicare, it’s what you don’t know WILL hurt you!

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. For a Medicare checkup, call the Toni Says call center at (832) 519-8664 or email info@tonisays.com regarding your Medicare plans and options. Toni Says Medicare Survival Guide Advanced edition is available at www.tonisays.com. Toni’s Medicare Moments articles have just been released: https://familytalktoday.com/medicare-moments.