There are some big changes affecting all Medicare beneficiaries this upcoming year. Here’s a summary of important points you need to know before choosing a new plan for 2025.

• Drug deductible: Most Prescription Drug plans (and Medicare Advantage plans that include Part D) will have a deductible increase. Deductibles for plan year 2025 cannot surpass $590.
• Elimination of the Coverage Gap: The coverage gap (or Donut Hole) will no longer exist as of 2025. After meeting their deductible, enrollees will pay a portion of covered drug costs until the out-of-pocket threshold of $2,000 is met. Afterwards, enrollees pay nothing for covered drugs for the rest of the plan year.
• Redefinition of TrOOP: TrOOP (True Out-of-Pocket Costs) is the amount spent on covered drugs that counts towards a beneficiary’s out-of-pocket threshold. The redefinition of TrOOP will now include enhanced alternative supplemental benefits offered by Part D sponsors (which are benefits that exceed the standard Part D model) and exclude payments using the new Discount Program.
• New Drug Payment Plans: Beneficiaries can now choose to spread their drug costs out with manageable installations rather than paying a large sum at the pharmacy for their prescriptions. Payment plans must be set up with your insurance provider.
• Medicare Advantage Plan Benefits Reduction: It is possible that many Advantage plans will begin cutting back on additional benefits like over-the-counter allowances and Part B givebacks. This is due to cuts in federal funding and increased plan spending.
• Benefit Usage Notice: Those who have Medicare Advantage plans will now receive a notice mid-year, advising them if they have unused benefits. Since Advantage plans usually carry additional benefits such as dental and vision care, enrollees will be notified about any benefits they are entitled to under their plan that they haven’t yet used.
• Dementia Care Expansion: The GUIDE program (Guiding an Improved Dementia Experience) will partner with more organizations to offer enhanced services to caregivers and people living with dementia. Some of the benefits include respite care, 24/7 access to care navigators, and caregiver training.
• Mental Health Prioritized: Medicare Advantage plans are now required to provide sufficient access to behavioral health practitioners like therapists, mental health counselors, opioid treatment providers, and drug counselors.

As you can see, there are many changes this year compared to previous years. Below you will find additional information on all topics mentioned. For additional Medicare help, visit myamacmedicare.com.

Resources:

Medicare Drug Price Negotiation Program: Negotiated Prices for Initial Price Applicability Year 2026 (cms.gov)

Final CY 2025 Part D Redesign Program Instructions Fact Sheet (cms.gov)

GUIDE Beneficiary and Caregiver Fact Sheet (cms.gov)

Exploring the Rise in Mental Health Care Use by Demographics and Insurance Status | KFF

Important New Changes to Improve Access to Behavioral Health in Medicare | CMS

For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a quote below!