Expert: Jon Ryan Graham

Licensed Independent Agent 

Is Part D prescription coverage changing in 2025?

Yes! The passage of The Inflation Reduction Act on August 16, 2022 requires the Centers for Medicare and Medicaid Services (CMS) to make significant changes to Part D, impacting how much Medicare Beneficiaries pay for their medications starting in January of 2025. The HIRA team is working diligently to understand the finer points of these new rules and communicate the potential impact to our clients. Since this is a change at the Federal level, everyone will be affected no matter which carrier you have your drug coverage through.  

Below is a helpful recap from the CMS.gov website:

· Annual deductible. The enrollee pays 100% of their gross covered prescription drug costs (GCPDC) until the deductible of $590 for CY 2025 is met.

· Initial coverage. The enrollee pays 25% coinsurance for covered Part D drugs. The sponsor typically pays 65% of the cost of applicable drugs and 75% of the cost of all other covered Part D drugs. The manufacturer, through the Discount Program, typically covers 10% of the cost of applicable drugs. This phase ends when the enrollee has reached the annual OOP threshold of $2,000 for CY 2025. 

· Catastrophic. The enrollee pays no cost sharing for covered Part D drugs. Sponsors typically pay 60% of the costs of all covered Part D drugs. The manufacturer pays a discount, typically equal to 20%, for applicable drugs. CMS pays a reinsurance subsidy equal to 20% of the costs of applicable drugs and equivalent to 40% of the costs of all other covered Part D drugs that are not applicable drugs.

https://www.cms.gov/newsroom/fact-sheets/final-cy-2025-part-d-redesign-program-instructions-fact-sheet

While we do not currently know how these changes will be reflected in actual plan designs, that information will be available and can be discussed after October 1, 2024.

Our message to everyone this year is:

Read your Annual Notice of Change (ANOC)! Medicare plans are required to send out these documents in September each year outlining what changes you can expect the following year.

Be mindful of who you discuss your Medicare coverage with! Change can be stressful, which can make you more vulnerable to unscrupulous people trying to change your plan for the wrong reasons.

If you do not already have a trusted agent, the team at HIRA is standing by to Make Medicare Easy! Give us a call!