Understanding how Medicare works is like grasping how a new iPhone works. Someone who still uses an iPhone 6 is comparable to someone who is on a Medicare plan from 2014. Speaking to someone who thinks there is no difference between the iPhone 6 and iPhone 16 is similar to communicating with someone who is still on a Part D plan from 10 years ago. The main difference between the two is that your iPhone is not costing you more money to use it.
Why would someone want to review their Medicare Part D every year? They most likely would not want to, but should they? YES! Every year, around September, people enrolled in a Part D plan get mailed something called an “annual notice of change (ANOC),” which basically says in really small print, your plan is going to cost you more money. Ok, how? Usually through premiums, copays, coinsurance and formulary changes.
1. Deductible – The deductible for 2025 is $590, up from $545 in 2024. This is the amount you owe before your insurance plan starts paying for your drugs.
2. Initial Coverage – During this phase, you pay 25% of your drug costs until you reach $2,000 in out-of-pocket spending.
3. Catastrophic Coverage – Once you reach $2,000 in out-of-pocket spending, you qualify for catastrophic coverage and will not pay any more out-of-pocket for covered Part D drugs for the rest of the year. Compared to 2024, the 2025 changes make it easier to reach catastrophic coverage.
As people age, they are typically prescribed more medications. If medications are “medically necessary” they are generally covered by their Part D plan.
Here is the issue: drugs for anorexia, weight loss, weight gain, fertility, erectile disfunction, cosmetic purposes, hair growth, prescription vitamins, minerals, over the counter medications, and drugs not listed in your plan’s formulary are not covered.
Most Medicare beneficiaries assume if a doctor prescribes a medication your Part D drug plan will help pay for them. This is unfortunately not true. Where and how people fill their prescriptions matters big time. Part D prescription drug plans generally have preferred pharmacies or mail order programs which will cost the Medicare beneficiary less money.
This is one of the most overlooked issues when it comes to saving money on drugs. The pharmacists are in the business of filling
your prescriptions and making sure you understand how to take your medication they are not in the Medicare insurance business. Don’t assume they are up to date with Part D plans in your zip code.
Make sure to speak with someone who is neutral between Medicare Supplements, Part D plans, and MAPD’s to determine the right path for your personal situation. Cowboys can lead the horse to water, but they can’t make them drink it. People have nothing to lose and everything to gain by speaking with a Medicare professional.
