There are some big changes affecting all Medicare beneficiaries this upcoming year. Here’s a summary of important points you need to know before choosing a new plan for 2025.
- Drug deductible: Most Prescription Drug plans (and Medicare Advantage plans that include Part D) will have a deductible increase. Deductibles for plan year 2025 cannot surpass $590.
- Elimination of the Coverage Gap: The coverage gap (or Donut Hole) will no longer exist as of 2025. After meeting their deductible, enrollees will pay a portion of covered drug costs until the out-of-pocket threshold of $2,000 is met. Afterwards, enrollees pay nothing for covered drugs for the rest of the plan year.
- Redefinition of TrOOP: TrOOP (True Out-of-Pocket Costs) is the amount spent on covered drugs that counts towards a beneficiary’s out-of-pocket threshold. The redefinition of TrOOP will now include enhanced alternative supplemental benefits offered by Part D sponsors (which are benefits that exceed the standard Part D model) and exclude payments using the new Discount Program.
- New Drug Payment Plans: Beneficiaries can now choose to spread their drug costs out with manageable installations rather than paying a large sum at the pharmacy for their prescriptions. Payment plans must be set up with your insurance provider.
- Medicare Advantage Plan Benefits Reduction: It is possible that many Advantage plans will begin cutting back on additional benefits like over-the-counter allowances and Part B givebacks. This is due to cuts in federal funding and increased plan spending.
- Benefit Usage Notice: Those who have Medicare Advantage plans will now receive a notice mid-year, advising them if they have unused benefits. Since Advantage plans usually carry additional benefits such as dental and vision care, enrollees will be notified about any benefits they are entitled to under their plan that they haven’t yet used.
- Dementia Care Expansion: The GUIDE program (Guiding an Improved Dementia Experience) will partner with more organizations to offer enhanced services to caregivers and people living with dementia. Some of the benefits include respite care, 24/7 access to care navigators, and caregiver training.
- Mental Health Prioritized: Medicare Advantage plans are now required to provide sufficient access to behavioral health practitioners like therapists, mental health counselors, opioid treatment providers, and drug counselors.
As you can see, there are many changes this year compared to previous years. Below you will find additional information on all topics mentioned. For additional Medicare help, visit myamacmedicare.com.
Resources:
Final CY 2025 Part D Redesign Program Instructions Fact Sheet (cms.gov)
GUIDE Beneficiary and Caregiver Fact Sheet (cms.gov)
Exploring the Rise in Mental Health Care Use by Demographics and Insurance Status | KFF
Important New Changes to Improve Access to Behavioral Health in Medicare | CMS
So after all the hype about how Trump wants to cut Medicare and Social Security, the Biden administration is cutting Medicare benefits for drugs. Delicious! Anybody in the press on this? Doubtful.
Most American’s that are covered by a Medicare Advantage Plan don’t realize how drastically the benefits can be changed year to year. Be sure to read the changes when they come in this month.
A lot of seniors will be going without their medications.A $520 dollar copay up front and the payment to the insurance company will be to high for most seniors.
Am I missing some that Laura C picked up from this article? Once the deductible of $590 is met (different policies have different deductibles). Currently drug costs that exceed $5030,(including deductible) will pay no more than 25% of the cost until $8,000 is reached. Once $8,000 is reached, there are no more payments for the year. Under Trump’s plan that is effective 2025, once $2,000 is paid for drugs there are no more costs to the insured for the rest of the year. That appears to be a lot of savings on drug costs that we currently don’t have now, not an increase.
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