The Inflation Reduction Action Act (IRA) enacted in 2022 included certain changes to the Medicare Part D program.

The first change came in 2024 when beneficiary copays and catastrophic coverage went from 5% to 0%.

Changes for next year:

• For 2025, there are two more major changes. No more coverage gap (Donut Hole) phase! Just 3 phases of coverage for 2025. Deductible, initial coverage, and catastrophic.
• A new $2000 out of pocket cap on beneficiary Part D expenses.

How does this affect me?

While these changes were designed to save beneficiaries money on the high cost of prescription medications, Medicare enrollees will see different outcomes depending on their unique situation. Keep reading to see how these changes may affect you.

I have Medicare Part D drug coverage

• No more coverage gap/donut hole
• $2,000 out-of-pocket maximum on prescriptions
• Ability to pay prescriptions annually out-of-pocket in monthly installments
• Possible increased monthly premiums on your Part D plan
• Possible changes to planned formularies/covered medications
• Possible changes to prescription copays

What if I have a Medicare Supplement?

This does not affect you. Keep as is!

What if I have Medicare Advantage?

• No more coverage gap/donut hole
• $2,000 out-of-pocket maximum on prescriptions
• Ability to pay annual prescriptions out-of-pocket in monthly installments
• Possible increased monthly premiums on your MAPD plan
• Possible changes to planned formularies/covered medications
• Possible changes to prescription copays
• Possible changes to ancillary benefits

What can I do about these changes?

Read your plan’s annual notice of changes (ANOC) when it arrives in September. Your ANOC will outline the changes to your Medicare plan’s benefits so you can see how you are potentially affected. If you have any questions or concerns about what this will mean for you please contact us!