Medicare Part D Enrollment

What You Need to Know

If you are 65 or older, make sure the Medicare Open Enrollment period, which runs from October 15 to December 7, 2024, is on your calendar. It is an important time of year to review your current medical coverage and healthcare needs — and select the most appropriate Medicare plan for the New Year.

Even if you are already enrolled in Medicare, it is still a good idea to review your plan, since coverage — and your health needs — may change from year to year. The LA Times found that only five percent of Medicare Part D patients were enrolled in the lowest-cost plan and those who switched plans saved almost $700. Many patients are unaware that they will automatically be re-enrolled in their current plan if they take no action, which could expose them to changes in benefits and premiums.

As we approach 2025, Medicare Part D beneficiaries will experience some significant changes designed to improve access to medications and reduce out-of-pocket costs. It is crucial for individuals on Medicare to stay informed about these updates and ensure they have the best plan for their needs. Here is what you need to know about the upcoming changes and why an annual review of your Medicare prescription drug plan is essential.

2025 Medicare Part D Highlights

Cost Improvements Due to the Inflation Reduction Act

The 2022 Inflation Reduction Act includes many updates to Medicare Part D. Improvements began in 2023 and will continue to be rolled out until 2029. Here are some important highlights for 2025 that may help keep your prescription drug costs down.

• The Coverage Gap (aka the Donut Hole) has been eliminated as of 2025. Instead, you will simply have a deductible, then a co-pay on prescriptions until you meet a total out-of-pocket limit. Then you will have no further costs for formulary drugs for the year.
• Your total out-of-pocket maximum will be dramatically reduced. In 2024, the total annual out-of-pocket limit was $8,000. For 2025, it is only $2,000.
• You will now have access to a Medicare Prescription Payment Plan. This will allow you to spread your out-of-pocket prescription costs out over the year rather than pay high out-of-pocket costs at the time they are incurred. To set up a payment plan, visit your plan’s website or call the customer service phone number on their website.
• The initial deductible will increase by $45 for 2025, to $590. This means you will pay slightly more before Medicare Part D begins paying its share if you have a plan with the highest possible deductible. After your deductible is met, you will pay a co-pay that varies based on the type of drug and your income. You will be responsible for those co-pays until you meet your RxMOOP (maximum out-of-pocket limit for formulary prescriptions). Some plans may offer a $0 deductible for lower-cost (Tier 1 and Tier 2) drugs. In this case, you will just pay a small co-pay for these drugs, even if you have not met your deductible yet. Vaccines are typically free of charge even if your deductible is not met yet, and insulin is always available with a $35 co-pay.
• RxMOOP (maximum out-of-pocket limit for formulary prescriptions) is now only $2,000 per year. This means that after you incur $2,000 in out-of-pocket costs for prescriptions included in your Medicare formulary, you will not pay anything extra for formulary drugs through the end of the year.

Why Annual Plan Reviews Are Crucial

1. Plan Variability: Medicare Part D plans can change from year to year, including drug formularies, premiums, and copayments. An annual review ensures you are enrolled in a plan that continues to meet your needs and is cost-effective.
2. New Drug Options: The list of covered drugs (formulary) and the costs associated with them may shift. Reviewing your plan annually helps you take advantage of new or better-covered medications and avoid surprises at the pharmacy counter.
3. Personalized Needs: Your health needs can change, and so can the plans available. By reviewing your plan each year, you ensure that you are getting the best coverage for your current prescriptions and medical conditions.

How to Prepare for Open Enrollment

• Gather Your Prescription Information: Make a list of all your medications, including dosages and frequencies. This will help you compare plans accurately.
• Review Current Coverage: Examine your current plan’s benefits and costs to understand what is working and what is not.

Your staff our AGHR_X RediScripts Pharmacies are here to help. Simply call us at the Atlantic General Hospital location at 410-641-9240, at the new Ocean Pines location at 410-629-6240, or email us at Rediscripts@atlanticgeneral.org, or visit us inside of either location. Our pharmacists have been trained to review your medication list and help you make informed decisions about your Medicare Part D plan. Just provide our pharmacy staff with a copy of your medication list and we will prepare a free personalized Medicare Part D plan comparison for you. Our pharmacists will make this available for your review and are happy to schedule a consultation with you to discuss the results right here at the pharmacy. Gather your medication lists and come see us before December 7 to start saving on your prescription medications in 2025.

If you will just become eligible for Medicare coverage for the first time in 2025, now is a good time to start learning about the different types of Medicare and what this means for you. Keep reading for our Medicare FAQ’s below.

FAQs

What are the different types of Medicare?

Medicare is an insurance plan provided by the federal government and overseen by the Centers for Medicare and Medicaid Services (CMS). Medicare coverage is divided into four general sections, each of which covers different services. You must be enrolled in Parts A and B to be eligible for Part D.

Medicare Part A covers hospital expenses (i.e., pays for costs if you are hospitalized or placed in a nursing home). Medicare Part B covers outpatient services, such as doctor’s visits, labs, immunizations, X-rays, and surgeries that do not require you to stay overnight in a hospital.

Medicare Part C, also known as Medicare Advantage, is a type of Medicare coverage offered by private insurance companies that contract with CMS. It is available to anyone enrolled in Medicare Parts A and B. Medicare Advantage plans cover not only the services provided by Parts A and B, but may also offer dental, vision, and/or prescription drug coverage.

Medicare Part D is a supplemental form of Medicare that specifically covers prescription drug services. If you are enrolled in Parts A and B, you can enroll in a Part D plan for prescription coverage.

Why would you want to get Medicare Part D?

Medicare Part A covers only medications that you receive while you are in a hospital or a skilled nursing facility. Medicare Part B covers only a limited number of medications and typically only if they are administered in an outpatient setting (such as a doctor’s office or clinic). Examples include vaccines, injectable medications, and medications administered via IV.

This lack of regular prescription coverage can be a significant problem for older adults. According to a 2018 report published by the CDC, more than 87% of adults aged 65+ take at least one prescription drug per month, and almost 40% take five or more prescription drugs monthly. If you are 65 or older, it is worth looking into how signing up for Medicare Part D coverage may save you money, especially if you are already taking multiple prescriptions.

Who qualifies for Medicare Part D?

Anyone who is eligible for Medicare coverage is also eligible for Medicare Part D. Generally, you will qualify for Medicare if you are 65 or older. People who are about to turn 65 can apply for Medicare outside of the regular open enrollment period during their 65th birthday month, as well as the three months before or after (although coverage does not start until you turn 65).

If you are under 65, you may also qualify under special circumstances: for example, if you’re disabled (and have been receiving disability checks from the Social Security Disability Insurance for at least 24 months), have end-stage renal disease, or have ALS (i.e., Lou Gehrig’s disease).

How can you sign up for Medicare Part D?

Our pharmacy staff at the AGHRx RediScripts locations can help get you pointed in the right direction here but if you like to perform your own research there are consumer tools available to assist you in just that!. Once you are enrolled in Medicare Parts A and B, you can sign up for Medicare Part D coverage on the Medicare Plan Finder page at medicage.gov. You can review and select health plans after entering your ZIP code and answering a series of questions. If you are already enrolled in a Medicare Part D plan, your plan will automatically renew, so technically, you’ll only need to visit the website if you want to change plans.

However, it’s still a good idea to review your plan every year in case your current plan has changed or to see whether a different plan would better fit your current needs. This 15-minute exercise is one of the most critical cost savings steps you can take each year to minimize your Medicare Part D drug costs.

How much does it cost?

The Medicare Plan Finder page will give you pricing information. You will be prompted to type in your list of medications and select your preferred pharmacy. The website will then provide a list of plans from which you can choose. The cost of your Medicare Part D plan may vary based on the plan you select and where you live. You will want to compare plan costs and co-pays to determine which plan will work best for you.

The pharmacists at AGHRX RediScripts can review the medications you currently take and help you find the best plan to fit your needs. Just call us or stop by.