What’s new for 2025
From Oct. 15 through Dec. 7, I encourage you to review and, if needed, change your Prescription Drug Plan under Part D coverage. Changes you elect will become effective on Jan. 1. Certified Medicare counselors across Alaska can help you as part of the Medicare Information Office’s network of program Ambassadors, including through your local Aging and Disability Resource Center (ADRC). Give us a call, we would be glad to answer your questions, guide you through the process, and even complete the review of your prescription drug plan with you.
Take the time to review your drug plan
Under Part D of Medicare, private insurance companies have established Prescription Drug Plans (PDPs). These plans meet the regulatory requirements of the national Centers for Medicare and Medicaid Services (CMS) along with complying with the State of Alaska’s rules overseen by the Dept. of Commerce and the Division of Insurance. These private insurance companies set up agreements with both drug manufacturers (the pharmaceutical companies) and distribution networks (the retail pharmacies); under a tiered pricing system, PDPs provide access to a list of prescription drugs, also known as their formulary.
Even if your current plan has been meeting all of your prescription needs, you may be able to obtain a new plan at a lower overall cost to you. For many reasons, these private insurance companies revise their offered plans annually. What has worked for you, may not work for you next year. To review your options, you may go online to Medicare.gov, then find the link for Health and Drug Plans. Without needing to create an account, you may use this online tool to review the medication you currently are prescribed, by entering the prescription name, its dosage, and how often you take it. You can also compare costs through local retail pharmacies. And you may be able to save money by using mail order delivery of your medications.
You may change to the plan of your choice
Once you have reviewed your options, you may elect to change to a new plan. The goal when searching for a new plan which meets all of your requirements is to obtain the lowest overall cost to you. Each plan may contain specific rules regarding your prescriptions, so read these notations carefully. The estimated annual cost is calculated by adding up the plan’s monthly premiums along with the cost-share of the prescriptions you anticipate obtaining during the year. While prescription drug plans offer a variety of deductibles, premiums and cost-shares, pay attention to the total estimated cost rather than one individual factor. During the open enrollment period (Oct. 15 through Dec. 7), you may even make multiple changes – the last change you make prior to Dec. 7 is the one which will become effective on Jan. 1, 2025.
Changes coming in 2025
Thanks to recent federal legislation, your annual out-of-pocket Part D costs will be capped at $2,000. This includes what you pay for your prescriptions’ copays or coinsurance during the year (including the plan deductible). This does not include the monthly drug plan premiums. After meeting the out-of-pocket limit, you pay $0 for covered Part D drugs for the rest of the year. This Also beginning in 2025, you will have the option to sign up for a payment plan for your Part D out-of-pocket costs. This program is called the Medicare Prescription Payment Plan, and you may also hear it referred to as “smoothing” costs. It lets you spread your drug costs out throughout the year. If you sign up, your Part D plan will send you a monthly bill, and you will pay $0 at the pharmacy. The payment plan does not reduce your out-of-pocket costs, but it can help people with high drug costs concentrated in the early months of the year manage their monthly expenses. To sign up for the payment plan, contact your Part D plan in 2025.
Summary of things to consider
Ask yourself the following questions before choosing a Part D drug plan:
Does the plan cover all the medications I take?
Does the plan have restrictions on my drugs, such as prior authorization, step therapy or quantity limits? Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug. Step therapy means that your plan requires you to try a cheaper version of your drug before it will cover the more expensive one. Quantity limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.
How much will I pay for monthly premiums and the annual deductible?
How much will I pay at the pharmacy (copay/coinsurance) for each drug I take?
Is my pharmacy in the plan’s preferred network? (You pay the least if you used preferred network pharmacies.)
Can I fill my prescriptions by mail order?
What is the plan’s star rating?
To discuss your options when choosing a Part D Prescription Drug Plan, or to ask any questions regarding your specific situation, please contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program.
If you are part of an agency or organization that assists Seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor for the Alaska Medicare Information Office.
