Toni: I received my new 2025 Part D premium with the plan increase going up by 250%, from $25.00 a month to over $60.00. I was informed that my diabetic insulin and one of my high blood pressure prescriptions are no longer covered beginning Jan. 1, 2025, on the Part D plan I am on.
Toni, please explain in easy-to-understand terms what I need to do to change my Part D plan before the Medicare Annual Enrollment Period (AEP) ends on Dec. 7. Thank you.
— Joanne from Cypress, Texas
Joanne: The Toni Says office phones are exploding because Americans are needing to change their Medicare Part D plans because of rising premiums or because the specific Part D plan they’re currently enrolled in is no longer in Medicare’s network. This issue is also appearing with Medicare Advantage plans throughout the United States.
First, let’s revisit Medicare’s Part D costs for 2025 and then I’ll explain in easy terms how to find the right Medicare Part D plan to meet your prescription drug needs for 2025.
Medicare Part D costs for 2025 are:
— Initial Deductible: $590.
— Initial Coverage: has 5 drug-tier stages; the Part D plan pays its share of the cost of your drugs, and you pay your share until the maximum amount of $2,000 out-of-pocket is met. Then you move into the Catastrophic Coverage stage and pay $0.
— Donut Hole (Coverage Gap): effective January 1, 2025, it will no longer exist.
Joanne, enrolling in a Medicare Part D or Medicare Advantage with Part D plan online requires you to have opened a www.medicare.gov account where your Medicare information can be obtained.
Once you have opened your Medicare.gov account, you can go online and begin searching for your prescription drug plan following these steps:
1. Click on “Find health and drug plans.”
2. Verify your “extra help” (based on income); list the pharmacies you prefer; under “Your Drug List,” list ALL of your drugs. Please enter the prescriptions into the system on a monthly basis, rather than a 3-month or 6-month basis, because of Medicare’s new $2,000 out-of-pocket maximum rule. Using monthly rates lets you know when you will qualify for the $2,000 out-of-pocket maximum and no longer have to pay the deductible or copay for the rest of the year. (When drugs are input on a quarterly basis, the $2,000 limit is not easy to find.)
3. Click on “Find Plan Now” and click “2025” to find 2025 Part D or Medicare Advantage plans. (Only click “2024” if you are new to Medicare and enrolling in Part D for the first time for a Dec. 2024 start.)
4. Select which plan you wish to enroll in, Medicare Advantage or Medicare Part D (stand-alone).
5. Explore your Part D options whether stand-alone or if you are already enrolled in a Medicare Advantage plan.
6. Joanne, your current plan that you are enrolled in will show up first with the 2025 premium that you said had a 250% increase. The plans listed after the one you are enrolled in are rated from the least out-of-pocket to the most out-of-pocket on the Medicare.gov site. Now is your time to explore your options and choose the plan that best meets your prescription and financial needs.
7. In the drug plan you are exploring, under the section titled “Estimated Total Monthly Drug Cost,” it will show when you meet the $2,000 out-of-pocket drug cost and have met your maximum 2025 yearly amount. Those with low drug costs are blessed and will not have to worry about meeting the $2,000 maximum.
Readers, you will want to take these steps to ensure that you sign up for the Medicare Part D plan that best meets your needs. Be sure to do so before the AEP ends on Dec. 7.