Month: September 2024

CMS (Centers for Medicare and Medicaid Services) has released the new costs for premiums and deductibles for 2025 Medicare coverage. Each year, costs are adjusted, deductibles and premiums re-set and released to the public. For the 2025 plan year the following costs will be in place for Original Medicare:

Part A Deductible: $1676 per hospital admission (unless within the same 60-day period)

Part B Premium: $185.00/month

Part B Deductible: $257/year

Part B Coinsurance: 20% (remains the same)

Part D Deductible: $590/annual– paid before prescription drug cost share begins**

Part D Initial Drug Phase: up to $2000 in out-of-pocket expenses

IRMAA – applies to single HH earning $106K or married HH earning $212K

Social security COLA Increase for 2025: 2.5%

**NEW for 2025 – There is a new Medicare Payment Plan M3P available to help spread out the costs of your prescription medications over a 12-month payment plan. Members of plans can enroll in the Rx Payment Plan beginning December 8 – 31 for Jan 1 2025 start. Enrollment in the payment plan is optional and administered directly by your MAPD/PDP carrier (NOT your pharmacy). Enroll directly with your carrier between December 8-31.

***NEW for 2025 – The Gap or Donut Hole phase of the Medicare Prescription Drug Plan has been eliminated for 2025. Catastrophic phase begins once you have incurred $2000 in out-of-pocket drug costs. Costs go to $0 during the Catastrophic phase. 2025 Drug plans now have 3 phases: Deductible, Initial, Catastrophic.

For most Rx plans in 2025:

Deductible: $590
Initial Phase: 25% cost share for medications until you reach $2000 in costs
Catastrophic: $0

Medicare resets its costs annually. These changes will take place beginning January 1, 2025 through December 31, 2025.

There have been a lot of changes underway with Medicare as a result of the Inflation Reduction Act signed in August 2022 by President Biden – the law expands Medicare benefits, lowers drug costs and has been enacted with the goal of improving the viability of the Medicare program for generations to come.  Short term, the law will help with reducing prescription drug costs.  A debilitating issue for so many on Medicare. 

A major aspect of the new law provides medicare the ability to negotiate drug prices directly with manufacturers to help gain control of the spiraling costs consumers are subjected to with many name brand medications. 

Now, we have the first 10 medicines that will be subject to Medicare price negotiations:

Januvia – Diabetes 
FIasp   –  Diabetes 
Novolog – Diabetes
Farxiga  – Diabetes, Heart Failure, Kidney Disease
Enbrel – Rheumatoid Arthritis, Psoriasis
Jardiance – DIabetes, Heart Failure, Kidney Disease
Stelara  –  Psoriasis, Crohn’s Disease, Ulcerative Colitis
Xarelto – Blood clots, coronery or peripheral artery disease
Eliquis – blood clots
Entresto – Heart Failure
Imbruvica – Blood Cancers

On average the cost reduction is approximately 60% with many higher and a few lower.  New pricing will begin January 1, 2026.  The new pricing is forecasted to save consumers an estimate $1.5 Billion in out of pocket costs and approximate $6 Billion to the Medicare program savings.  Negotiations began in February 2024 and concluded August 2024.