Medicare's Plan Year 2025 Annual Enrollment Period is almost here!

The 2025 Annual Enrollment Period runs from From Oct 15 to Dec 7. The new plans were announced on Oct 1 and are viewable on your My Medicare account.  Barring special circumstances, this is the only time of year you may change your drug plan.  Those with MA plans have two enrollment seasons; this one, and also January 1 to March 31.  Medicare supplements do not have an annual enrollment season; they may be reviewed or changed anytime of year, most commonly at your policy anniversary date.

In 2025 we'll see the biggest improvements to the Part D progam since it began in 2006.  With those improvements come some big disruptions, as plans adjust to the additional coverage they will be required to provide.  It's never been more important to review your drug coverage.

Here are some of the biggest changes:

• Several drug plans are not being renewed for 2025.  The number of Part D drug plans offered in 2025 is being reduced by one-third.  If your plan is being terminated, but your insurance carrier has other drug plans continuing next year, you will be auto-enrolled into one of them. They do this so you're not left uncovered, but the plan they move you to may not be the right one for you.  You may either allow the auto-enroll to take place by taking no action, or enroll in another plan. If your Part D carrier is discontinuing all of their drug plans, you will not be auto-enrolled in to any other plan.

Your Part D insurance carrier will notify you by mail if your plan is being terminated.  We'll also notify all affected clients by email if we did the enrollment or you let us know what plan you last self-enrolled in.  Terminated members get a Special Election to choose a different drug plan until Feb 28.

• A first-ever out-of-pocket max ($2,000) will be imposed on drug plans.  The max only applies to covered drugs, so the most important thing those taking brand-name drugs can do is confirm their plan covers their drugs.  Any drug not on the plan's formulary has no out-of-pocket limit.  Your Medicare account will display all drug plans in your state ranked from lowest to highest total annual cost.

The cap could be much lower than $2K for many.  After your deductible is met you get credit for 25% of the cost of brand-name drugs toward your $2K OOP max, even if your copay is lower than 25% of the drug’s full cost.  Example: let’s say your brand name drug retails for $400.  You get 25% of this amount, or $100, credited toward your OOP, even if your copay for that drug is only $50.  Depending on the plan and the drugs taken, many will reach this new $2K max before reaching $1K in actual out-of-pocket expense.  The higher premium plans are more likely to have copays less than 25%.  This can be difficult to calculate, but the good news is you don’t have to.  Your MyMedicare.gov account will factor this in when estimating costs and ranking the plans by total annual cost for your drugs.

• In 2025 the two lowest premium plans (and 6 of the 8 lowest) have gone consumer-direct.  This means they no longer work with agents, who are only allowed to provide information on plans they represent (see the mandatory Medicare disclaimer below).  We want to make sure you’re in the right plan for you, even if it doesn’t work with agents, and are fortunate that our Medicare supplement renewals are sufficient that we can do that.  We are allowed to help you while you’re logged in to your account if you need it.  We have created a step-by-step  pdf document, with screenshots, to help you review your drug plan on your Medicare account: Rx Plan Review and Enroll Guidance.  We are available to assist our Medicare supplement clients review their drug coverage.  Please contact us while logged in to your account.

• The only place you may enroll in all drug plans is on your My Medicare account at www.MyMedicare.gov (make sure you're on the .gov Official Medicare website), or by calling (800) MEDICARE.  Your drug list on your My Medicare account is updated automatically from your pharmacy claims, so the drug name, dosage, and frequency all match what you had filled.

• The new Medicare Patient Payment Plan (M3P) begins in January.  This allows you to spread your deductible and copays in even payments through the end of the year.  Instead of paying your deductible at the pharmacy at the start of the new year, your plan will front the money to the pharmacy and you pay nothing at checkout.  Your plan will estimate your annual drug costs, divide that by the remaining months in the year, and bill you.  The M3P program requires registration with your plan.  Medicare has a great website with all the details: M3P Overview

From October 1-14, you can see next year's plans, and on October 15 the enroll button will be activated.  Any plan change made by December 7 takes effect on January 1.  Medicare will notify your current plan that you're leaving, so you don't need to cancel it.

Important note: if you are new to Medicare because you are turning 65, or are older than 65 and leaving employer group health coverage, you do not have a December 7 deadline.  Your deadline varies based on your birth month or date your employment or employer drug coverage ends.  Please contact us for details.

If you have questions or need help while in your Medicare account, please call us or send an email to info@castleseniorbenefits.com.

New Mandatory Medicare disclaimer regarding drug plans and Medicare Advantage plans:

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY Users should call 1-877-486-2048) 24 hours a day/7 days a week, or your local State Health Insurance Plan (SHIP), to get information on all of your options (this required disclaimer does not apply to Medicare supplement plans).