Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Lawley Medicare Solutions Learning Center:

Ask Janell!

 

QUESTION:  I just received a notice about my prescription drug plan. It costs $3.70 this year, but next year it will be $38.70! What can I do about that huge increase?

ANSWER:  Insurance Season is finally here! It’s my favorite time of year, but 2025 could be shocking for many people. For 2025, we keep hearing about “significant market disruption.” In Medicare, that means more plans than usual will be discontinued in 2025, and a significant increase in premiums for many of the plans still being offered, like your Prescription Drug Plan.

In New York State, the average premium for prescription coverage in 2024 is about $48/month. In 2025, the New York State average premium will be $72.34/month. So, while your $38.70 monthly premium is a significant increase from 2024, it’s still well below the statewide average premium.

In New York State, in 2024, 15 stand-alone Prescription Drug Plans are available, but in 2025 that drops to 12. People enrolled in the three discontinued plans will be moved to a similar plan with the same insurance company. It’s important for you to review the material that your insurance company sends. It explains the new premiums, coverage rules, and pharmacy policies.

A major change in 2025 is that no one will spend more than $2,000 for any medication covered by Medicare Part D. In 2024, that spending maximum was over $8,000, so that drop to $2,000 is excellent for people with many medications or an expensive medication. It’s important to evaluate your coverage and make sure it still includes your medications. I recently wrote an article just about this spending change, so you can refer to that article for more information.

By now, everyone with Medicare has been informed of their plan changes for 2025, including premiums, copays, and other relevant information. You still have time to decide what happens next.

The Annual Enrollment Period (AEP) is October 15 through December 7, and this is when you can make changes to your Medicare coverage. I highly recommend taking time to review your coverage needs around the AEP. A great way to review your options is to visit www.medicare.gov or call Medicare representatives at 1-800-MEDICARE (800-633-4227). These services help review your medical needs compared to available plans.

You can also meet with professional advisors, like insurance brokers, the Office for the Aging, or other local services. At Lawley Medicare Solutions, our team of licensed and experienced Medicare Consultants is here to help you compare plans and answer any personal questions you have about your coverage. We offer phone, virtual, or in-office appointments to suit your needs.

In 2025, there will also be significant medication pricing differences between pharmacies. So the plan you have now may not change, but the pharmacy you’ve used may cost significantly more than a different pharmacy, possibly one right down the street.

I’ve heard from people who don’t like paying their Prescription Drug Plan premiums and don’t feel they “need” the coverage. I still caution them against dropping coverage. If you decide to drop your prescription drug coverage, you’re penalized later if you try to enroll in a new Prescription Drug Plan. The penalty is 1% of the average premium per month you are without drug coverage. Since the average premium is $72 per month, that is a $0.72 penalty for each month you’re uninsured. If you skip drug coverage for 2025, that’s $0.72 X 12 months, making your penalty $8.64. When you add drug coverage again in 2026, that $8.64 will be tacked onto your premiums each month—and you will pay it each month for the rest of your life. This obviously adds up quickly. So even though coverage might occasionally feel like it’s not worth the premium cost, a penalty like this truly is nothing but an unnecessary cost with no benefit to you.

It’s also important to understand that insurance is meant to protect us from what MIGHT happen. So maybe you don’t see much of a benefit to keeping your drug coverage now, but that could change quickly with a new prescription or change in a drug price.

I look forward to the Medicare Annual Enrollment Period every year. The new plans, the new coverage, and the benefits offered present an opportunity for everyone to change their situation for the better. Don’t hesitate to contact our team at Lawley Insurance to evaluate your options and ensure you’re making the best choices for your healthcare needs.

If you have questions or need assistance navigating your options, don’t hesitate to reach out to the Lawley Medicare Solutions Team. You can contact Medicare Service Team Lead Gabrielle Connor at 716.849.8223, or submit an inquiry through our contact from below. We’re here to help you find the right coverage for your needs!

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.