Time to Review Your Medicare Prescription Coverage!

It’s the annual open enrollment season for Medicare once again! Open enrollment started Tuesday, October 15^th and runs through December 7^th.  If you're a Medicare beneficiary, you have the opportunity now to review your current coverage and consider other options. Any changes you make will be effective January 1, 2025, and if you do nothing your current coverage will remain in place. Although you may be eligible to change both your healthcare and prescription plans, we're going to focus on Medicare Prescription Drug Plans (PDPs) in this post. Let's talk first about the changes coming to PDPs in 2025.

New Medicare Rules for Prescription Drug Plans

Starting in 2025, there will no longer be a "donut hole", or coverage gap, in Medicare prescription insurance plans. That's big news! And that goes along with a maximum out-of-pocket expense of $2,000 for the year. Deductibles and co-pays/co-insurance will count toward that $2,000 (not premiums though). Once you've reached the $2,000 limit, you'll skip the coverage gap and go straight to "Catastrophic Coverage".

There's a change in catastrophic coverage, too. Until the end of this year, it's meant your co-pays went down, but you still had to pay something. Starting next year, there will be no co-pay or co-insurance after that $2000 maximum is reached. So now you can count on not spending more than $2,000 for your medications if you have a Medicare PDP. That's great news!

Don't get me wrong, I know $2,000 is a big number and some folks can't afford even that. If you find yourself in that situation, look into Medicare's "Extra Help" program. It's based on income and can be a huge help for people with few resources. But even for those with higher incomes, drug costs can be scary, so these upcoming changes will be welcome.

The other big change is that you can now work with your PDP to spread your payments out over the course of the year. No more huge bills in January and February as you pay your deductible or purchase expensive meds. Your insurer will work with you to predict your costs and come up with a payment plan. You'll have to call your insurer directly to inquire about this option and set it up. It may mean that you pay the insurer directly rather than paying at the pharmacy counter. If you choose to go this route, be sure you understand who, when, and how much you're expected to pay.

Some basic information

If you’re new to Medicare, or to Prescription Drug coverage, you may want to learn more about how PDP plans work. What is a formulary? A tier? What about the deductible,  out-of-pocket maximum, and catastrophic coverage? Check out the embedded links to learn more.

Getting started

Your current healthcare and prescription plans likely already sent you information about their planned changes for 2025. If you haven't already, read through those handbooks as soon as possible. The information there will help you quickly decide if your coverage will be the same or different next year. For example, the handbook that I received from my PDP contained a table that stated very clearly what my benefits have been in 2024, and what they will be next year. And once that's clear, it's easier to decide on next steps.

Comparing plans

The easiest way for you to look at other PDPs is to sign into your Medicare.gov account. When you use your own account, the information you enter will be saved. If you don’t have time to finish your research, you can log out and it’ll all still be there when you come back. Registering for an account is easy, and gives you access to many online features of Medicare. I highly recommend it!

Once signed in, you’ll be able to see your current coverage, including both regular healthcare and your PDP plan. From there, simply click on the “Find Health and Drug Plans” button. Once you enter the information that will help get you individualized results you'll get a list of all the available Part D plans in your area. The list can be filtered (organized) in a number of ways. Maybe you want to see results from only one or two insurance companies, or focus mostly on the monthly premium or annual deductible, for example. Organize the list in whatever way makes most sense to you.

Specific details of each plan are there as well. Do you want to compare how much a particular medication costs using one plan versus another? Can you expect to reach your maximum out-of-pocket cost in 2025, and if so, when? 

Even better, you can compare up to three plans head-to-head. That makes it a little easier to see differences quickly. Just click on the "compare" button (right next to the "plan details" button) to add a plan to the list for comparison.

Do-it-yourself or ask for help!

If you're one of the many people who just don't enjoy navigating websites, never fear.  There are skilled and trustworthy Medicare experts out there who can help you. You'll find one such expert featured at the bottom of the "About Us" page right here on the Better My Meds website! Or contact BetterMyMeds directly to set up an appointment to compare PDPs!

Either way, comparing plans may help you find a plan that better meets your needs. You might also find out that your current plan, even if it frustrates you sometimes, is still the best one for you. But at least you’ll know.

Time will fly, so don’t wait too long!

Open enrollment will end on December 7. Take some time now to consider your alternatives. Remember, if you want to keep the same plan you don't have to do anything. You only need to sign up by December 7 if you want to switch to a different plan.

As always, please share questions and comments in the space below. Or contact us directly at Better My Meds – we love hearing from you!

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