What They’re Saying:
Top 7 Questions About
“The Big Disruption”
1. What is the new $2,000 cap on prescription drug costs, and how does it work?
Answer: Starting in 2025, Medicare Part D will limit your annual out-of-pocket spending on prescription drugs to $2,000. Once you hit that amount in a calendar year, your plan will cover 100% of your prescription costs for the rest of the year. This helps protect beneficiaries from high drug costs.
2. Will my insulin still be affordable in 2025?
Answer: Yes. Insulin will remain capped at $35 per month for all Medicare beneficiaries under Part D. This cap ensures that you won’t pay more than $35 each month for insulin, regardless of how much you need.
3. How will Medicare’s ability to negotiate drug prices affect me?
Answer: In 2025, Medicare will begin negotiating prices for some of the most expensive prescription drugs. While it may take time for these negotiations to reduce prices, this will likely lead to lower costs for medications that are commonly used by beneficiaries over the coming years.
4. Are there changes to Medicare Advantage benefits for chronic conditions?
Answer: Yes. Medicare Advantage plans are expanding their offerings for people with chronic conditions like diabetes, heart disease, and respiratory illnesses. This could include benefits like transportation to appointments, meal delivery, and home health services tailored to help manage these conditions.
5. Will telehealth services still be available in Medicare Advantage plans?
Answer: Yes. Telehealth services, which became more popular during the pandemic, will continue to be covered under Medicare Advantage plans in 2025. You’ll be able to access virtual visits with your primary care doctor, specialists, and mental health providers from home.
6. Do I need to review my Medicare plan during the Annual Enrollment Period?
Answer: Absolutely. The Annual Enrollment Period (October 15 to December 7) is the time to review your current plan and see if it still meets your needs. With new benefits, lower drug costs, and expanded services in 2025, it’s important to compare plans and make changes if necessary.
7. What should I do if I think I qualify for financial assistance with my drug costs?
Answer: In 2025, more beneficiaries will qualify for **Extra Help**, a program that helps cover Part D costs. If your income and assets fall within the new, expanded limits, you may be eligible for reduced premiums, deductibles, and copays for your medications. Contact Medicare or a licensed Medicare agent to check your eligibility.
These changes offer better financial protection and more options for managing your health, so it’s a great time to review your coverage.