Your Guide to the 2025 Medicare Changes

Medicare can feel confusing, and every year brings some changes. For 2025, there are a few updates to Medicare prescription drug coverage, also called Part D, that may affect what you pay at the pharmacy. Here is a plain language overview of the changes many of our patients are asking about.

Plans differ, so always check the details of your own plan or speak with a licensed Medicare counselor.

A yearly cap on drug costs

Starting in 2025, Medicare Part D includes a yearly limit on what you pay out of pocket for covered prescription drugs. The cap is $2,000 for the year. Once you reach that amount on covered medicines, you generally do not pay more for covered drugs for the rest of the year. For people who take several medicines or expensive medicines, this can make a real difference.

The coverage gap goes away

You may remember the coverage gap, often called the donut hole, when costs could suddenly go up partway through the year. With the new cap, the coverage gap phase is gone for 2025. Costs work in simpler stages.

Spreading out your costs

There is also a new option called the Medicare Prescription Payment Plan. It lets you spread your out of pocket drug costs into monthly payments across the year, instead of paying a large amount at the pharmacy all at once. This does not lower the total amount you owe, but it can make costs easier to manage. You can sign up through your Part D or Medicare Advantage plan.

Here are a few more points to keep in mind:

• Insulin covered by your plan continues to have a monthly cost limit of $35
• Many recommended adult vaccines covered under Part D have no out of pocket cost
• Plans can change which drugs they cover and their costs each year
• Extra Help is a program that can lower costs for people with limited income
• Open enrollment runs from October 15 to December 7 each year

Every fall, take a few minutes to compare your plan. The plan that was best last year may not be best this year.

At our pharmacy, we can help you understand what your plan covers for your medicines, check whether a lower cost option may be available, and talk with your doctor if a medicine needs prior approval. We can explain things in English or Spanish.

For help comparing plans, California offers free, unbiased Medicare counseling through HICAP, the Health Insurance Counseling and Advocacy Program. You can also call 1-800-MEDICARE or visit Medicare.gov.

If you are not sure whether we accept your plan, just call us and we will check for you.

Keep your list handy

When you compare plans, bring a current list of your medicines with the names and strengths. A free medication review is a great way to make sure your list is complete and up to date before open enrollment.

Call us at 661.941.4402 to confirm your plan or request a free medication review.

This article is general education, not medical advice.