Did you know Part D prescription drug coverage is the benefit people typically use the most when they buy a Medicare Advantage health plan? Prescription drug coverage also tends to be the part of Medicare people ask the most questions about, like “What are drug tiers?” and “What’s the donut hole and how much will my medications cost when I get there?”
If you’re shopping for a Medicare plan with drug coverage this year during Medicare’s Annual Enrollment Period, which begins October 15, you’re in luck. Thanks to new legislation, Medicare prescription drug coverage is getting a lot simpler for people in 2025.
Here are some of the changes Medicare members will see beginning January 1, 2025:
- A $2,000 cap on out-of-pocket prescription drug expenses: This means if you have Medicare Part D prescription drug coverage, you won’t pay more than $2,000 per year on covered drugs.
- No more confusing coverage gap stage, also called the “donut hole”: People with Part D coverage will no longer have to worry about falling into the donut hole, where they were previously responsible for more of their drug costs.
- A payment plan option for prescription drugs: People with Part D plans now will have the option to spread out their prescription drug costs over the year instead of getting hit with a big bill all at once.
In 2024, Medicare expanded its Extra Help program, which helps people pay their Part D prescription drug premium and out-of-pocket drug costs. If you qualify for Extra Help, you won’t have to pay a premium for your plan or a deductible, plus you’ll pay less for your generic and brand-name drugs at the pharmacy.
To see if you are eligible for Extra Help to pay your prescription drug costs:
- Visit SSA.gov/ExtraHelp.
- You can also visit your local Social Security office or call 1-800-772-1213. (TTY users, call 1-800-325-0778).
- For more information, check out Medicare.gov/ExtraHelp
New to Medicare this year? Then make sure to sign up for Part D prescription drug coverage as soon as you are first eligible for it. If you go without prescription drug coverage, you may have to pay a late enrollment penalty—and it’s not a one-time payment. If you have to pay a late enrollment penalty, this amount will be added to your Part D premium for as long as you have a Part D plan.
Medicare’s Annual Enrollment Period starts October 15 and lasts through December 7. If you have any questions about Medicare drug coverage and how it works, Florida Blue Medicare offers resources to help. You can check it out at FloridaBlue.com/Medicare and click Learn About Medicare.
Your neighborhood Florida Blue Center is also a great resource whether you’re a Florida Blue member or not. You can ask questions face to face. No appointment is necessary. Find a Center near you at FloridaBlue.com/Center or call1-877-352-5830.
Sources:
https://www.medicare.gov/basics/costs/help/drug-costs
https://www.cms.gov/files/document/lis-extra-help-article-june-2023.pdf
