Key Takeaways

• Medicare Part D coverage isn’t set in stone—plans can change their costs, formularies, and pharmacy networks each year. Reviewing your coverage before the Medicare Open Enrollment period ends ensures you won’t face unexpected costs in 2025.

• If your medications are no longer covered or your plan’s pricing structure has changed, you still have time to switch before you’re locked in for another year.

Are Your Medications Still Covered?

One of the most important things to check in your Medicare Part D plan is whether your prescriptions are still included in the plan’s formulary. Each year, insurance companies update their covered drug lists, meaning that a medication you relied on in 2024 might be placed in a different tier or removed altogether in 2025.

What to Look For

• Tier Changes: Drugs may shift to a higher tier, increasing out-of-pocket costs.

• Removal from Formulary: If a drug is no longer covered, you may need to find an alternative or request an exception.

• Prior Authorization Requirements: Some medications may now require approval before coverage kicks in.

• Step Therapy Requirements: Some plans may require you to try a less expensive drug before approving a more costly one.

• Quantity Limits: Certain medications may now have new restrictions on how much you can get at one time.

Has Your Plan Raised Its Costs?

Medicare Part D plans can adjust their premiums, deductibles, copayments, and coinsurance rates every year. Even if your plan still covers your medications, you might pay more out-of-pocket in 2025 than you did in 2024.

Key Cost Factors to Check

• Monthly Premiums: Have they increased compared to last year?

• Annual Deductible: Medicare sets a maximum deductible, but each plan may choose a lower amount.

• Copayments and Coinsurance: The cost you pay for each prescription may have changed.

• Coverage Gap Considerations: Some plans may increase costs when you enter the coverage gap (or “donut hole”).

• Catastrophic Coverage Changes: New rules in 2025 eliminate out-of-pocket costs beyond $2,000, which can impact how much you spend overall.

Are Your Preferred Pharmacies Still in Network?

Pharmacy networks can change from year to year. Even if you’ve used the same pharmacy for years, it’s worth checking to make sure it’s still part of your Medicare Part D plan’s preferred network. If your pharmacy is now out-of-network, you could face much higher costs.

What to Verify

• Preferred vs. Standard Pharmacies: Plans often charge less at preferred pharmacies.

• Out-of-Network Pricing: If your pharmacy is no longer in-network, switching to an in-network option may save you money.

• Mail-Order Pharmacy Availability: Some plans offer discounts for using mail-order services.

• Retail vs. Specialty Pharmacies: Certain medications may now require you to use a specialty pharmacy instead of a regular retail location.

Have You Reached the Catastrophic Coverage Phase?

As of 2025, Medicare has introduced a major change—once you hit $2,000 in out-of-pocket drug costs, you no longer have to pay for covered prescription drugs for the rest of the year. If you’ve previously reached the catastrophic coverage phase, this update provides significant financial relief.

Steps to Take

• Review Your Drug Spending: Have you hit the $2,000 threshold yet?

• Check Plan Options: Some plans may still be better suited to your specific medication needs.

• Look for Extra Assistance: Certain state programs or drug manufacturers may still offer financial assistance.

Do You Qualify for Extra Help?

If your income and resources fall within certain limits, you may qualify for the Extra Help program, which lowers your Medicare Part D costs. The income limits for 2025 have increased, so even if you didn’t qualify last year, it’s worth checking again.

How Extra Help Can Benefit You

• Lower Premiums and Deductibles: Some or all of your Part D costs may be covered.

• Reduced Copayments: Medications could cost significantly less out-of-pocket.

• Protection from Cost Increases: You may avoid sudden price hikes or changes in formulary coverage.

• Automatic Enrollment in Some Plans: If you qualify, Medicare may enroll you in a benchmark plan.

Are There Better Plan Options Available?

Even if your current plan hasn’t changed much, there might be a better option available. Medicare Open Enrollment, which runs from October to December, is the only time most people can switch plans.

What to Compare

• Formulary Coverage: Does another plan cover your medications at a lower cost?

• Cost Structure: Would another plan save you money on premiums, deductibles, and copays?

• Pharmacy Network: Does a different plan include more pharmacies near you?

• Medication Therapy Management Programs: Some plans offer additional support for managing chronic conditions.

• Out-of-Pocket Spending Limits: With the new $2,000 out-of-pocket cap, compare how different plans apply this limit.

What If You Miss the Deadline?

If you miss the Medicare Open Enrollment deadline, you may be stuck with your current plan for another year. However, there are a few exceptions where you might still be able to make changes.

Special Enrollment Periods (SEPs)

• Moving to a New State: If you relocate, you may qualify for a Special Enrollment Period.

• Losing Employer or Union Coverage: If you lose creditable drug coverage, you can switch to a new Part D plan.

• Becoming Eligible for Extra Help: You can enroll in a plan or switch plans at any time if you qualify for Extra Help.

Making the Right Choice Before the Deadline

Before Medicare Open Enrollment ends, take the time to review your Medicare Part D coverage carefully. If you find a better option, switching now can prevent unnecessary expenses and disruptions in 2025. For expert guidance, get in touch with a licensed agent listed on this website to explore your best options.