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. The 18th century poet Thomas Gray said, “Where ignorance is bliss, ’tis folly to be wise.” We say ignorance is not bliss, it is expensive.
Why would someone want to review their Medicare Part D every year?
They most likely would not, 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, co-insurance and formulary changes.
For 2025, the Medicare Part D prescription drug benefit has three phases:
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 dysfunction, 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.
"Where ignorance is bliss, 'tis folly to be wise."
A lot of changes have also occurred around how agents get paid when it comes to Part D prescription drug plans, and they are less incentivized to help Medicare beneficiaries. Also, zero dollar Medicare Advantage Prescription Drug Plans (MAPD’s) with extra benefits for dental, vision, and hearing have complicated the conversation.
Make sure to speak with someone who is neutral between Medicare Supplements, Part D plans, and MAPD’s. If someone is passionate about one solution over another, they might need a little more experience. It is fairly easy for a Medicare professional 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. If you are not working with someone, give us a call – we are licensed in multiple states and would be happy to help you. If you know someone who is turning sixty-five, download a free copy of “Book of Medicare”, it was intentionally written to help people aging into Medicare.