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Legislative Changes to Medicare Insurance in 2025

Wednesday August 28, 2024 - Jennifer Prell
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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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