Reviewing prescription drug and health coverage options during Medicare’s open enrollment period is extremely important.
More than 67 million with Medicare can review their options and make changes from Oct. 15 through Dec. 7, and those who miss the deadline will likely have to wait another year to make any changes.
Recommended Videos
Starting in 2025, all Medicare plans will include a $2,000 cap on what individuals pay out of pocket for covered prescription drugs, which only applies to drugs covered by a specific insurance plan.
It’s the first time out-of-pocket prescription drug costs will be capped annually thanks to the Inflation Reduction Act (IRA). Under the new law, enrollees will also have the option to pay those costs in the form of capped monthly installment payments instead of all at once at the pharmacy.
Medicare patients who take high-cost drugs for cancer and other serious conditions will save thousands with the prescription drug cap, but those with basic prescriptions could be negatively impacted.
AARP estimates that in 2025, 3.2 million Americans, or 8.4% of all those with a Part D drug plan, will reach the cap.
The changes mean that some insurers are cutting unprofitable plans and removing benefits like dental coverage, or increasing premiums and co-payments, which could lead to many seniors paying more money for fewer benefits.
Bill Green, a local Medicare insurance agent at Green Insurance, says everyone needs to review their plan options now to make sure their drugs are covered.
“If you didn’t get an annual Notice of Change letter from your plan, you may have gotten a letter saying your plan is exiting the market next year...That means that your plan won’t exist and you have to pick something new,” Green said.
He continued, “If you ignore it, you will end up next year with no drug coverage and 20% of cost with no limits. So basically, [people] have two options: Either pick a new Medicare Advantage plan or, on that letter, it lays out the steps to get into a Medicare supplement or Medigap plan without any health questions.”
If you’re considering a Medicare Advantage plan for the lower premium, it’s important to note that many companies are shrinking benefits and limiting access to certain providers.
You can input the list of prescriptions you are taking and do a side-by-side comparison of plan coverage, costs, and quality ratings on Medicare.gov.