The Centers for Medicare & Medicaid Services has made several positive changes to Medicare Part D for 2025. Understanding how these changes will impact you will make it easier to prepare for the new benefit year.
What you need to know:
- The Coverage Gap Stage will be eliminated. Members enrolled in Medicare Part D have faced what is known as the Coverage Gap Stage, where they had to pay 25% of costs for brand and generic drugs. When this is eliminated in January 2025, Part D enrollees will no longer experience the change to their cost sharing when they move from the Initial Coverage Stage to the Catastrophic Gap Stage.
- $2,000 out-of-pocket maximum for prescription drugs. Effective 2025, Medicare Part D enrollees will enjoy an annual $2,000 maximum on their out-of-pocket on prescription drug costs — significantly less than 2024.
- $0 cost sharing for the Catastrophic Coverage Stage. Once an enrollee reaches their $2,000 out-of-pocket maximum, they will pay $0 in Part D prescription drug cost sharing for the rest of the year.
- The Medicare Prescription Payment Plan. In 2025, Medicare beneficiaries will have the option to “smooth” their prescription drug costs over the plan year by paying a monthly bill rather than having to pay for medications all at once at the pharmacy. This can help members who may be living on a lower, fixed monthly income to avoid higher out-of-pocket expenses the first few months of the year.
Additionally, Advantage MD has made the following changes to Medicare Part D pharmacy benefits in 2025 that may affect you.*
- A $590 deductible for Tiers 3 through 5 will be applied to all Advantage MD plans.
- A 25% coinsurance will apply for Tier 3 through 5 prescription drugs once the deductible has been fulfilled.
*Not applicable to D-SNP or Group plans.
Our Member Services team is ready to answer any questions you have and help you get the most out of your plan. Call HMO: 877-293-4998 (TTY: 711) or PPO: 877-293-5325 (TTY: 711).
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