Enrollment
Medicare Part D also called Prescription Drug Plans are also offered by private insurance companies, and you can comparison shop and choose a plan that best suits your needs.
Part D
Medicare Part D is voluntary, meaning you can choose to have a Prescription Drug Plan. But be careful, if you do not enroll into a Prescription Drug Plan or a plan that includes Prescription Drug coverage, you will be penalized by Medicare. Prescription Drug Plans are often coupled with a Medicare Supplement plan to give more of a complete cover for their members. Remember that Medicare Advantage plans include prescription drug coverage. If you do enroll in Part D when you are first eligible, you will be able to access retail prescription drugs at a more affordable rate and enjoy protection against high costs in the event you need a very expensive medication.
Cost
$2,000 Out-of-Pocket Cap: One of the biggest changes in 2025 is the introduction of a $2,000 annual cap on out-of-pocket costs for prescription drugs. Once you’ve spent $2,000 on covered prescriptions, Medicare will cover the rest for the year.
Elimination of the Donut Hole: The infamous “donut hole” or coverage gap will be fully eliminated in 2025. Previously, beneficiaries had to pay more out-of-pocket for prescription drugs after reaching a certain spending limit. Now, after reaching the deductible and initial coverage phase, beneficiaries move directly to catastrophic coverage once out-of-pocket costs hit the cap.
Monthly Payment Flexibility: Starting in 2025, beneficiaries will have the option to spread their out-of-pocket expenses over the year in monthly installments, helping to manage medication costs more effectively.
Enhanced Coverage for Vaccines: Part D will continue to offer vaccines at no cost to the patient, including shingles and other preventive vaccines, ensuring access to essential immunizations.
Lower Costs for Insulin: The cap on insulin prices, initiated in 2023, will continue in 2025, limiting out-of-pocket costs to $35 per month for insulin products, regardless of coverage phase.
Consideration
These updates to Medicare Part D for 2025 are part of an effort to make prescription drugs more affordable and accessible for all beneficiaries.
How does it work
When you purchase prescriptions at the pharmacy, your Prescription Drug Plan allows for affordable co-pay for your medication. Medications in a Prescription Drug Plan are grouped into tiers that have specific pricing. From your generic drugs to your specialty drugs, your Prescription Drug Plan can offer you coverage. Each time you must purchase a prescription drug in the corresponding tier, you pay the tier co-pay.
Enrollment
You are eligible for Prescription Drug Plans when you first become eligible for Medicare (at age 65). You can consult with one of our Licensed Medicare Agents, who will be happy to explain your plan options, or you can enroll in a Prescription Drug Plan directly through Medicare. Call 1-800-MEDICARE or visit Medicare’s website for enrollment information. If you don’t enroll in Medicare Part D when you are first eligible for Medicare, you can elect a plan later. Each year, during Medicare’s Annual Election Period from October 15 to December 7, you can add, drop, or change your plan selections.
Medicare FAQ's
You are eligible to apply for Medicare during your initial enrollment period which is a 7 month window. 3 months before turning 65, the month you turn 65 and 3 months after turning 65.
The easiest way to sign up for Medicare is online through SSA.gov or by Calling Social Security at 1-800-772-1213. You can also visit your local Social Security Office.
If you are already receiving Social Security benefits you will be automatically enrolled into Original Medicare, otherwise you will be eligible to enroll during your initial enrollment period that starts 3 months before your 65th birthday.
If you miss your Initial Enrollment Period you can sign up during the General Enrollment period that occurs every year January 1st through March 31st. Coverage becomes effective the month following your enrollment date.
Yes, there are penalties for not signing up for Part B of Medicare and will be added to your premium.
If you need a new Medicare card you can order a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call.
Medicare has neither endorsed nor reviewed this information. Not connected or affiliated with any United States Government or State agency.
We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program
(SHIP) to get information on all of your options.
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