Legislative Changes to Medicare Insurance in 2025
Wednesday August 28, 2024 - Jennifer Prell
Medicare
Open Enrollment doesn’t start until October 15, but you need to be aware of
significant benefit changes for Prescription Part D plans in 2025. Two Major Medicare changes due to the Inflation Reduction Act —
Medicare Part D maximum out-of-pocket (OOP) costs will be
reduced to $2,000- Coverage Gap or “donut hole” ceases
- Potential impacts of the Rx OOP reduction
- Carriers may increase Part D premium rates to absorb the
additional liability
- Carriers may reduce their formulary list
- Carriers may change their preferred pharmacy networks seeking
better discounts
- Carriers may choose of all the changed listed above
Medicare Prescription Payment Plan- Helps seniors on fixed incomes afford their high-cost drugs
early the year (prior to deductible or OOP being fully met)
- Carriers must set up a billing payment plan for seniors who
request this program and are taking a drug or drugs that cost $600 or more
- An optional program for Medicare beneficiary
- Carriers will divide the cost of drugs evenly between months
- Insured people will receive two bills, one bill for the
premium, second bill for pro-ration claims
- Carriers are working on how to administratively implement the
Medicare Prescription Payment Plan
If
you have a Prescription Part D plan, look for your Annual Notice of Change
(ANOC) booklet arriving in late September. The ANOC provides a summary of any
changes in your Part D plan’s costs and coverage for January 1 of 2025.
Lori Marin of Envision Benefits provided the information above.
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