Medicare Part D, offered by private companies, is optional prescription drug coverage for those with Medicare, covering brand-name and generic drugs, with costs varying based on plan and drug tiers.
Key Features of Part D:
· Optional Coverage:
You can choose to add Part D to Original Medicare (Parts A & B) or select a Medicare Advantage plan that includes Part D.
· Plan Options:
Part D plans have different formularies (lists of covered drugs) and cost structures, including monthly premiums, copays, and coinsurance.
· Covered Drugs:
Part D covers a wide range of prescription drugs, including those in protected classes like cancer and HIV/AIDS drugs.
· Plan Costs:
You pay a monthly premium for your Part D plan and then pay a copay or coinsurance for your medications.
· Phases of Coverage:
Part D coverage progresses through three phases: deductible (until deductible met), initial coverage (plan helps pay), and catastrophic coverage (once an out-of-pocket limit of $2,000 is reached, you don’t pay anything).
· No More Donut Hole:
The coverage gap, often referred to as the “donut hole”, is gone, and there are now three phases of coverage instead of four.
New For 2025, Medicare Part D enrollees will now benefit from a capped out-of-pocket spending limit of $2,000 for covered prescription drugs and the option to spread their payments throughout the year through a new Medicare Prescription Payment Plan.
Here’s a summary of key changes and highlights:
1. The New Out-of-Pocket Cost Cap:
· Again, beginning in 2025, your yearly out-of-pocket drug costs will be capped at $2,000, meaning you won’t pay more than that amount for covered Part D drugs.
· Once you reach this cap, you don’t have to pay copayments or coinsurance for covered Part D drugs for the rest of the calendar year.
· This cap applies to all Part D plans, including both traditional Medicare and Medicare Advantage plans with prescription drug coverage.
2. Medicare Prescription Payment Plan:
· Part D plan sponsors must now provide enrollees with the option to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year, rather than all at once to the pharmacy.
· This option is designed to help beneficiaries manage their out-of-pocket costs and potentially budget better for their medications.
3. Continued Insulin Cap:
· People with Medicare Part D coverage continue to pay no more than $35 for a month’s supply of covered insulin products.
4. Expanded Access to Extra Help:
· The Inflation Reduction Act expanded eligibility for the Low-Income Subsidy (LIS), also known as “Extra Help,” to include individuals who were previously eligible for only partial benefits.
Need More Help?
If you’re still not sure which path is right for you, local help is available. Feel free to call our local office at: 806-350-7380 to book a quick no-obligation drug plan review – or visit us online at: www.medicareamarillo.com