Medicare Part D Changes for 2025
In this article, we wanted to provide an update on the important changes coming to Medicare Part D beginning January 1, 2025.
The Centers for Medicare & Medicaid Services (CMS) recently announced plans to overhaul the Medicare Part D prescription drug program significantly. Thankfully, these changes will reduce out-of-pocket expenses, expand drug coverage, and simplify the program's structure for easier navigation. Key changes include:
Capped Out-of-Pocket Expenses: Beginning in 2025, your annual out-of-pocket spending for covered Part D drugs will not exceed $2,000(down from $8,000 in 2024). This change is particularly beneficial if you take high-priced medications.
Elimination of the Coverage Gap/Donut Hole: Beginning in 2025, Part D will simplify down to three phases: deductible period(Up to $545 in 2024 and up to $590 in 2025), initial coverage, and catastrophic coverage. The re-design of Part D eliminates the phase of the coverage gap (also known as the donut hole) that currently follows the initial coverage phase and where you generally pay more for covered medications. Removing the coverage gap means you will no longer face a change in your cost sharing when transitioning from the initial coverage phase.
Medicare Prescription Payment Plan: Beginning in 2025, each Medicare prescription drug plan must allow members to pay out-of-pocket prescription costs in capped monthly installments rather than all at once at the pharmacy. This applies to Advantage plans with Part D as well.
A more detailed official CMS(Centers for Medicare & Medicaid Services) fact sheet can be found via this link: https://www.cms.gov/files/document/fact-sheet-final-cy-2025-part-d-redesign-program-instructions.pdf