Revive: Now Is The Time To Review Your 2025 Part D Drug Coverage

Consider this your Medicare Open Enrollment reminder. The Annual Open Enrollment Period ends December 7, and only around 30% of drug plan enrollees tend to pay attention when looking ahead at changes coming their way – usually because their coverage doesn’t significantly change or they find the process too bothersome and costly.

But this year is special because of the Inflation Reduction Act’s changes. Part D coverage seems like something out of a blender – we must now find our way through its mysterious contents!

10 Important Details Regarding 2024 Open Enrollment

Since my previous article in February 2018, I’ve been very active reviewing drug coverage for numerous clients. This list can have an enormous impact on their future drug coverage in 2025 and underscores why open enrollment is such an essential service.

1. Your plan may no longer be accessible next year.

KFF reported that 2025 will see 26% fewer plans available, equivalent to approximately six plans in each area.

Changes that could prove costly include discontinuance of plans; insurers automatically enroll you into another plan after this occurs unless you make specific requests to opt-out or change plans manually. My friend now knows this; her zero-premium drug plan would soon go away and would likely be replaced with one with an $45 monthly premium payment option.

2. Premiums in 2025 will vary dramatically – an analysis of 46 plans across three ZIP codes shows a wide array of premium change scenarios.

3. Your plan’s formulary could change.
Plans removing certain medications from their list is nothing new; but, this year seems different as more clients whose long-term prescription won’t be covered next year are scrambling to find alternative medicines to manage chronic conditions.

4. CMS estimates that Part D drug plan quality has declined significantly since 2022, when almost 42% were in plans with four stars or higher; now only around five percent will enroll in such plans, down from almost 42% then and 10 five-star plans and no two-star plans, in 2022 (nine two-star plans versus two five-star). (Medicare Advantage plans have seen similar decreases.)

Tier 6 has disbanded. Over the last several years, some plans had Tier 6, which consisted of select generic medications for blood pressure, cholesterol and diabetes at significantly reduced costs; often no copayment required! Most noteworthy was that some plans classified Jardiance and Ozempic as Tier 6, often with only an $11 copayment payment required!

6. Preferred brand drugs belonging to Tier 3, will cost more. This happens when plans substitute a copayment with coinsurance instead, such as making $47 become 17% or increasing their percentage from 15%-18%; which occurs in almost 40% of Los Angeles ZIP code plans.

7. Tier 4 in some plans is structured differently from traditional copayment plans: rather, it functions more as coinsurance for nonpreferred brand prescriptions at Tier 4. Based on my review of drug plans last year, higher premiums often had copays of $45-47 associated with Tier 4, nonpreferred brand coverage.

8. When it comes to cost sharing between standard and preferred pharmacies, the differences can be considerable.
Be mindful when considering pharmacy expenses; preferred pharmacies do not always represent the lowest cost option. I have noticed significant variance in cost sharing between standard and preferred plans this year.
Client takes six Tier 2 drugs and four Tier 1 generics that seem cheap enough; his annual costs would total approximately $1,560 at his usual pharmacy (standard), but zero at one further away (preferred). That is because Tier 1 and Tier 2 medications at preferred pharmacies require no copay payment while at standard pharmacies copayment costs range between $10-15 for Tier 1 drugs and $15 each for Tier 2.

9. Grocery store pharmacies remain competitive in pricing. Most Medicare beneficiaries grew up during an era in which milk, bread and pills could all be obtained at one store; now however things have evolved: one client estimated their drug costs could drop from $670 per year down to $60 by switching their pharmacy of choice in their grocery store instead.

Estimated Medicare Plan Finder costs can change overnight. I began reviewing plans Monday afternoon, finished it Tuesday morning and found my “total + premium cost” had changed (increasing). Unfortunately there’s nothing you can do about that other than accept that estimated costs serve merely as an easy way to compare plans without providing detailed budget details – if costs increase for one plan they likely increase across all plans as a whole.

Facts About Part D Life in 2025

Your current plan may no longer exist. If it does, be ready for higher costs than anticipated when switching. Don’t expect a four or five star plan; rather expect that any pharmacy chosen could change significantly and your costs might become unpredictable and fluctuate drastically over time.

Now is the time to reevaluate your drug coverage and make any needed adjustments, since those who put off making decisions until later usually end up regretting it later on. Don’t delay as those who leave this task unfinished could suffer serious repercussions later.