Expanding eligibility for full benefits under the Part D Low-Income Subsidy program in 2024. Adding a hard cap on out-of-pocket drug spending under Part D by eliminating the 5% coinsurance requirement for catastrophic coverage in 2024 and capping out-of-pocket spending at $2,000 in 2025.
The estimated average enrollment-weighted monthly premium for Medicare Part D stand-alone PDPs is projected to be $45 in 2025, a modest increase from $42 in 2024 (based on June 2024 enrollment).
In California, enrollees in 8 of the 16 national PDPs offered in 2024 will see their premiums increase by $35 if they do not switch to a different plan in 2025, while enrollees in 6 other national PDPs in 2024 will see a premium reduction.
In 2024, for example, you reached the Part D donut hole when you and your plan had paid $5,030 for your medications. Prior to 2019, if you reached the coverage gap, you would have to pay 100% of your prescription drug costs in that period until you met the catastrophic coverage period spending threshold.
Key takeaways:
You may want to consider using GoodRx instead of Medicare when Medicare doesn't cover your medication, when you won't reach your annual deductible, or when you're in the coverage gap phase (“donut hole”) of your Medicare plan. GoodRx's prescription drug prices are frequently cheaper than Medicare copays.
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
Health systems have cited delayed reimbursements, cumbersome prior authorization requirements and high rates of patient claim denials for their decisions to drop Medicare Advantage plans.
"Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield. These companies stood out based on plan types offered, premiums, discounts, complaint rates and nationwide availability."
Part D cost sharing
A monthly Part D plan premium (average estimated premium in 2024 is $46.50) An annual deductible (maximum $590 in 2025) A copayment or coinsurance during the initial coverage period.
To qualify to get $144 added back to your Social Security check, you can enroll in a Medicare Advantage plan that offers a Part B premium reduction or giveback benefit.
In 2025, the standard monthly premium for Medicare Part B will be $185, an increase of $10.30 from the 2024 amount. The deductible for Part B services will be $257, a $17 increase from the deductible of $240 in 2024.
Medicare Part D cap of $2,000
Beginning January 1, 2025, people with Part D plans through traditional Medicare and Medicare Advantage plans with prescription drug coverage won't pay more than $2,000 over the calendar year in out-of-pocket costs for their prescription medications.
This year, people with Medicare Part D prescription drug coverage will benefit from a new $2,000 out-of-pocket cap on prescription drug costs. The new out-of-pocket cap is just one of the ways the Inflation Reduction Act is working to lower drug costs and make health care more accessible for everyone.
Disadvantages of Medicare Advantage plans can include difficulty switching out of the plans later, restrictions on care access, limited provider networks, and limitations on extra benefits.
Hospitals opt out
A survey of health systems by the Health Care Management Association revealed that 19% had stopped accepting one or more Medicare Advantage plans in 2023. And 61% reported that they were either considering or planning to stop accepting all Medicare Advantage patients within the next two years.
The company said the main reason for that drop is that the 2025 rating for its H5216 plan, which contains about 45% of Humana's MA membership, fell to 3.5 stars from 4.5 stars in 2024. The H5216 plan also includes more than 90% of its employer group waiver plan membership.
But MA plans have some potential disadvantages. They have smaller provider networks and often require prior authorization. And with an MA plan, you won't have access to Medigap supplement insurance to cover your out-of-pocket costs. Those drawbacks can limit access and affordability for enrollees.
eligibility for Medi-Cal. For new Medi-Cal applications only, current asset limits are $130,000 for one person and $65,000 for each additional household member, up to 10. Starting on January 1, 2024, Medi-Cal applications will no longer ask for asset information.
There could be several reasons why Social Security stopped withholding your Medicare Part B premium. One common reason is that your income has exceeded the threshold for premium assistance. Another reason could be that there was a mistake or error in your records.
Medicare Part A (hospital insurance)
You're eligible for Part A at no cost at age 65 if 1 of the following applies: • You receive or are eligible to receive benefits from Social Security or the Railroad Retirement Board (RRB).
Are pharmacies required to accept GoodRx coupons? Participating pharmacies are required to accept GoodRx through contracts with their pharmacy benefit managers (PBMs). An exception is for controlled medications. Accepting a GoodRx coupon for a controlled medication is always at the discretion of the pharmacist.
In 2025, the Medicare Part D coverage gap, also known as the “donut hole,” will be eliminated under the Inflation Reduction Act (IRA). Part D plan members will also enjoy the security of an annual maximum out-of-pocket cost for prescription drugs.
You can use most GoodRx discounts instead of your Medicare Part D or Advantage plan if the GoodRx price is less than your co-pay. However, you can't combine the two. If the pharmacist tries to process the discount with your Medicare information, the discount will not be applied.