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.
- The Coverage Gap Phase will be eliminated. Members enrolled in Medicare Part D have faced what is known as the Coverage Gap Phase, 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 Phase to the Catastrophic Gap Phase.
- $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 — thousands less than 2024.
- $0 cost sharing for the Catastrophic Coverage Phase. Once an enrollee reaches their $2,000 out-of-pocket maximum, they will pay $0 in 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 (except D-SNP, Group and HMO Tribute plans).
- A 25% coinsurance will apply for Tier 3 through 5 prescription drugs once the deductible has been fulfilled.
Our Member Services team is ready to answer any questions you have and help you get the most out of your plan at 877-293-4998 (TTY: 711).