I keep hearing about Medicare Part D changes for 2025. Will these actually lower what I pay for my prescriptions?

Question

Joseph Bachmeier · Accepted Answer

The biggest change in 2025 was closing the coverage gap also known as the "Donut Hole".
If your drugs are covered under your plan's formulary then you will spend no more than $2000 per year, no matter how expensive your prescriptions are. That is great news for folks who have been spending 4,5, 6 even 7 thousand a year. However, if you are taking a very expensive drug that is not covered under the Medicare formulary you could end up spending more than the 2K cap.

Lt Col Tim Brown · Answer

It could. If you are on expensive meds like Jardiance and Trulicity, the most anyone could pay in 2025, no matter how many meds they are on is $2,000. If your on generics, you will have cheap to no copays.

Answered by Lt Col Tim Brown on April 15, 2025

Broker Licensed in TN, AL, CO & 10 other states

Answered by Lt Col Tim Brown Medicare Insurance Agent

Robert Pennington · Answer

The changes for 2025 will not affect prescription prices. Rather than have the donut hole and a $8000+ max out of pocket, the most any senior will pay in 2025 will be $2000. This can be set up on a 12 month pay from SS or you can pay as you go until you pay $2000 out of pocket and pay $0 for the rest of the year.

Answered by Robert Pennington on April 21, 2025

Broker Licensed in NC, GA, SC & VA

Answered by Robert Pennington Medicare Insurance Agent

Jonathan Potter · Answer

Yes, the cost for the part D plans did go up and the deductibles are very high but it will reduce what you pay for medications only if you take name brand drugs. If you don't take non generic drugs then you can get away with getting on the cheapest plan available. 

Lets say that you take a drug that costs $500 retail. The first month on the plan you would pay your deductible and then a copay of around $45. The next three months you would just pay the $45 copay. Then for the rest of the year that medication should be free because you have hit your $2000 max drug coverage.

David Quintal · Answer

In 2025, Medicare Part D has several changes. The changes include a $2,000 annual out-of-pocket limit for prescription drug costs, the elimination of the coverage gap (aka "donut hole) and new options for spreading drug costs throughout the year.

Answered by David Quintal on April 21, 2025

Broker Licensed in NH, AL, AZ & 14 other states

Answered by David Quintal Medicare Insurance Agent

Kent Pike · Answer

This overall is true, out of Pocket Cost have been lowered to $2,000 in Part D Expenses.  This has been a real game changer for a lot of people.

Ja&#039;el Michael · Answer

It depends, the Inflation Reduction Act of 2025 reduced the out of pocket maximum from $8000 to $2000 specifically for Medicare presciption coverage. So if you have expensive medications, this could absolutely save thousands of people significant money, also ensuring they don't need to stop taking vital medications due to cost.

Alternatively, in that transition, more cost was put on the insurance companies, which can effect members. After this change many Medicare Advantage plans added deductibles on prescriptions and had to decrease some of the added value benefits to make up the cost. 

Overall, the most important things to keep in mind:
1) Review your prescription coverage EVERY October. They can change drastically. 
2) While reviewing it, make sure your prescriptions are in the plan formulary. Otherwise, the cost for those prescription does not count toward your out of pocket maximum.

Steven Bleicher · Answer

The “Inflation Reduction Act” of 2023/24 put forth a maximum out of pocket (for Medicare members) for all Prescription drugs (both generic & brand name) at no greater than $2,000.00 per year. Prior to that law, it used to be $8,050/year! What a difference for folks who are prescribed a variety of Rx's!

Answered by Steven Bleicher on May 23, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Timothy Brown · Answer

The donut hole has been eliminated for 2025 and the overall annual maximum out pocket has been reduced $2000. Once the maximum has been met, the cost of the prescriptions will be $0 for the remainder of the year. It doesn’t necessarily lower the cost but you’ll reach the annual maximum much faster. There’s also a program called M3P which allows you to spread the cost of the prescriptions on a monthly basis.

Answered by Timothy Brown on June 1, 2025

Broker Licensed in PA, CT, DE & 15 other states

Answered by Timothy Brown Medicare Insurance Agent

Tammy Stoner · Answer

The changes to Medicare part D for 2025 are that there is a cap to how much a person would spend for medications. It does not lower the cost of Medications

If a person has expected costs over $2000 for medications, they are encouraged to enroll in their plans PPP prescription payment plan.  The plan will take over billing and budget over the year the cost of medications to $2000. You will no longer pay the pharmacy but send a monthly payment in to the plan.

Cleo Martin · Answer

Maybe not on each prescription, the the maximum amount you could spend in a year has gone down from $8000 to $2000. And the $2000 is made up of what you and others spend. So it could be less.

Steven Maicus II · Answer

Yes, the changes to Medicare Part D for 2025 are designed to lower your out-of-pocket costs for prescription drugs. Specifically, the annual out-of-pocket limit for covered drugs will be capped at $2,000. Once you reach this limit, you won't have to pay any copayments or coinsurance for covered Part D drugs for the rest of the year.

Answered by Steven Maicus II on May 19, 2025

Agent Licensed in NY

Answered by Steven Maicus II Medicare Insurance Agent

Joanna Gebhart · Answer

Yes, there were several changes to Medicare Part D for 2025. Many of the carriers have reduced the cost of some of the expensive medications. Additionally the Out of Pocket Maximum you will pay for all prescriptions is $2,000, down from almost $9,000 last year. The Donut Hole has been eliminated. This is a significant reduction and makes your annual cost much less. Additionally, there is a monthly no cost payment plan for those who know their medications will cost more than $2,000 in the year. This makes the monthly payment for all medications under $170 per month.

Answered by Joanna Gebhart on April 8, 2025

Broker Licensed in CA, OR & TX

Answered by Joanna Gebhart Medicare Insurance Agent

Fred Manas · Answer

Yes, the changes to Medicare Part D for 2025 are expected to lower prescription drug costs for many beneficiaries, especially those with high drug costs. The key change is the elimination of the coverage gap ("donut hole") and the establishment of a $2,000 out-of-pocket cap. 
Here's a more detailed look:
$2,000 Out-of-Pocket Cap:
In 2025, you will not pay more than $2,000 in out-of-pocket expenses for covered Part D drugs, according to The National Council on Aging. This includes the deductible, copays, and coinsurance. 
Elimination of Coverage Gap:
The "donut hole," where you were responsible for 25% of your prescription drug costs after reaching a certain spending limit, is gone. Once you reach the $2,000 out-of-pocket limit, your Part D plan will cover the rest of the cost for the year. 
Catastrophic Coverage:
After reaching the $2,000 out-of-pocket limit, you will not have to pay anything out of pocket for covered Part D drugs for the rest of the calendar year. 
Potential Savings:
The Centers for Medicare & Medicaid Services (CMS) says that the changes will reduce out-of-pocket spending for beneficiaries by an estimated $7.4 billion annually. 
Medicare Prescription Payment Plan:
You can now choose to pay for your prescription drug costs in monthly installments instead of all at once. This can be helpful for those with high drug costs that might hit the $2,000 cap early in the year.

Vachik Chakhbazian · Answer

Yes, the changes to Medicare Part D for 2025 are designed to lower your out-of-pocket costs for prescription drugs. Specifically, the annual out-of-pocket limit for covered drugs will be capped at $2,000. Once you reach this limit, you won't have to pay any copayments or coinsurance for covered Part D drugs for the rest of the year.

Answered by Steven Maicus II on May 19, 2025

Agent Licensed in NY

Deborah Webster · Answer

Yes, the max in 2025 is 2,000 while the max in 2024 was 8,000. There may be deductibles on your plan if you are on brand-name medications. Work with your agent to determine whether the deductible will apply on your medications.

Answered by Deborah Webster on May 15, 2025

Broker Licensed in Ia & SC

Answered by Deborah Webster Medicare Insurance Agent

Robert Simm · Answer

For the majority of Medicare beneficiaries that have Tier 1 or tier 2 medications then they won't feel the impact of the new law under the Inflation Reduction Act. If your medications are coming up a little expensive when you pick them up at the pharmacy you can always reach out to your health insurance broker or insurance company to ask them if there's any reduction that you could possibly get for the cost of the medications or you can ask your provider to see if there is a financial incentive for the manufacturer the medication to reduce that cost there for you.

Answered by Robert Simm on April 7, 2025

Broker Licensed in NC, AL, AR & 15 other states

Answered by Robert Simm Medicare Insurance Agent

Todd Bostic · Answer

A couple of the changes that may be helpful is that the "Donut Hole" as it was commonly referred to, is eliminated. That should lower some higher cost medications, but if you are still having trouble with your medications being higher, you can pay them out over the course of the rest of the year now. Basically, if you get a medication in June, you can pay it out for the rest of the year, and it doesn't matter when you get it, you can pay it out over the rest of the year.

Answered by Todd Bostic on May 28, 2025

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic Medicare Insurance Agent

Ron Gambles · Answer

As of today, the current cost structure is that the highest prescription drug deductible is $590. After that the cost to you will be 25% of the cost in the form of coinsurance until your prescription drug expenditure reaches a max of $2000. This includes any payments made on your behalf from the Extra Help program.

Answered by Ron Gambles on April 17, 2025

Agent Licensed in TN

Answered by Ron Gambles Medicare Insurance Agent

Shannon Mayfield · Answer

While there were some major changes for 2025, how they effect each person will depend on the individuals prescriptions. In order to effectively evaluate impact, it would be important to get the whole picutre of what an idividual's needs are.

Answered by Shannon Mayfield on May 19, 2025

Broker Licensed in ID

Answered by Shannon Mayfield Medicare Insurance Agent

Jennifer Dixon · Answer

They have gotten rid of the donut hole.  To answer that question you need to speak with an agent so he/she can go over all the medications that you take.

Sophia Davis · Answer

In many instances, yes! Most commonly used medications will remain primarily stable. Patients who take Tier 3 or higher medications, but not enough medications to reach the Max-Out-Of-Pocket threshold, will likely be most affected.

Answered by Sophia Davis on April 16, 2025

Agent Licensed in OH

Answered by Sophia Davis Medicare Insurance Agent

Mark Murphy · Answer

Most likely.  Before 2025 the catastrophic level on the Rx plans was $8000 out of your pocket before your drug prices dropped to $0 for the rest of the year.  Starting in January of 2025 the catastrophic level is now $2000.  Once you've spent $2000 in copays your drug costs drop to $0 until January 1, 2026.
I say most likely because most seniors have low-cost generic drugs.  On most Rx plans those copays can run from $0 copay to about a $15 copay.  The $2000 catastrophic level will help seniors that take drugs that have no generic brand available and are paying the higher coinsurances or copays.

I keep hearing about Medicare Part D changes for 2025. Will these actually lower what I pay for my prescriptions?

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I keep hearing about Medicare Part D changes for 2025. Will these actually lower what I pay for my prescriptions?

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