Medicare Capping Drug Costs in 2025
Posted on Tuesday, October 8th, 2024
Starting in 2025, Medicare beneficiaries will see their out-of-pocket costs for outpatient prescription drugs capped at $2,000.
They also will be able to spread their out-of-pocket costs over a year if they opt into the new Medicare Prescription Payment Plan.
Now is the time to compare your current Medicare prescription drug plan against the plans that will be available in Oklahoma as of January 1, 2025. An open enrollment period begins October 15 and ends December 7.
Unbiased senior enrollment counselors (SHIPs) are an 800# away through the State Insurance Department, as described later.
Here’s what’s coming in 2025:
· New: The Inflation Reduction Act is rolling out a $2,000 out-of-pocket spending cap on all Medicare Part D plans and on Medicare Advantage plans that offer outpatient drug coverage. On average, beneficiaries with high-priced drugs will save $1,300 over last year.
· New: The deductible for most Part D plans will be $590 a year.
· New: In 2025, the “coverage gap” and “doughnut hole” are being eliminated. Now, with the new out-of-pocket max of $2,000, participants will need to pay their deductible (up to $590), then make copayments until they reach the new maximum, getting them to the next level of coverage faster than previous years.
· New: Installment payments, if you opt for this new payment option, all of your out-of-pocket costs, starting with the first covered prescription filled, will be spread out over the rest of the year. You will not need to bring money to the pharmacy for Part D plan drugs; just pick up your prescription and go. The Part D plan will bill you in equal monthly installments for your accumulated deductible and copayments. And remember, once your total out-of-pocket costs reach $2,000, there will be no further charges for covered prescriptions.
THE MOST IMPORTANT take-away for Part D in 2025 is checking in with an unbiased expert on plan searches.
In Oklahoma, you will find that help from the Senior Health Insurance Program (SHIP) counselors at the Oklahoma Insurance Department.
The call is free. The help is free. Have your prescription list or bottles at hand when you call. Be able to state the name of each of your prescription drugs, the dosage, and the frequency.
The SHIP counselor will conduct a search of the 17 Part D plans available in Oklahoma in 2025. He or she will advise you of the plans that cover all or most, and certainly the most expensive, drugs in your list. You will be able to make a plan choice and enroll.
The counselor also will explain the installment payment option and enroll you in that program if you want it.
In recent years, Part D plan searches in Love County were performed by SHIPs at Mercy Health Love County Hospital in Marietta. That service is suspended while the hospital is being rebuilt following a tornado.
So, call SHIP at the State Insurance Department, at 800-763-2828. Call between October 15 and December 7 to be sure your enrollment choices become effective January 1, 2025.
SHIP is well-versed in everything Medicare: Parts A and B and C (Medicare Advantage), Supplemental Plans, etc.
Also, you have the option of searching Part D plans on your own at www.medicare.gov. This is the official Medicare website. After October 15, click on the tab labeled “Health and Drug Plans.” Follow the steps shown for entering your drug list and see resulting costs, from low to high, under the various Oklahoma Part D plans for 2025.