Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Lawley Medicare Solutions Learning Center:

Ask Janell!

 

QUESTION: What changes do I need to know about the 2025 insurance season, particularly regarding prescription drug coverage?

ANSWER:

As we approach the 2025 insurance season, significant changes are on the horizon, particularly regarding prescription drug coverage. Here’s what you need to know:

Key Changes for 2025

  1. No Coverage Gap (Donut Hole): One of the most notable changes is the elimination of the coverage gap, commonly referred to as the “donut hole.” This means that beneficiaries will no longer face increased costs for medications after reaching a certain spending threshold.
  2. Deductibles and Initial Coverage Phase: For 2025, the maximum deductible for Medicare Part D plans will be capped at $590. After meeting this deductible, you will enter the Initial Coverage phase, where your medications will be divided into tiers. Your copay will depend on the tier assigned to each medication.
  3. Out-of-Pocket Maximum: In 2025, your copays will accumulate toward a maximum out-of-pocket limit of $2,000. Once you reach this amount, your copays for covered medications will drop to $0 for the remainder of the year.
  4. Changes to Medication Tiers: Each insurance plan categorizes medications into tiers, and while your medications may remain the same, the tiers can change annually. It’s essential to review the Annual Notice of Change (ANOC) packet to understand if your medications have been reassigned to a different tier, which can affect your costs.
  5. Medicare Advantage Plans: If you are enrolled in a Medicare Advantage Plan, you will receive an ANOC that outlines changes to your monthly premium, the Part D prescription drug benefit, and any adjustments to health insurance copay structures. Be sure to read this information carefully to understand how your coverage may change.

Next Steps

As you prepare for the 2025 Annual Enrollment Period, October 15 to December 7, take the time to research and understand these changes. If you have questions or need assistance, we encourage you to reach out to the Lawley Medicare Solutions Team. Contact Medicare Service Team Lead Gabrielle Connor at 716.849.8223, or submit an inquiry with our contact form below. Our team is here to help you navigate your options and secure the best coverage for your needs. Happy Insurance Season!

 

At Lawley Medicare Solutions, our Medicare and Individual Health Consultants are dedicated to helping you make the most informed decisions about your healthcare needs. We offer personalized service and expert advice tailored to your unique situation. Contact us today by phone or email to schedule a consultation and ensure you’re getting the best coverage for your needs.

 

Read all Inside Medicare articles HERE.

 

LAWLEY HAS A TEAM DEDICATED TO MEDICARE INSURANCE!

Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur.

For questions, concerns, or to reach Lawley Medicare Solutions, fill out the contact form below or call 716.849.1540.