The big news is that there will be a $2,000 cap on out-of-pocket spending on Part D plans. This includes Advantage plans, however they have historically had lower costs than their Part D counterparts. What we may see in response to this mandate is the increase in the deductible and cost of the Tier 1 and Tier 2 generics, changes in tiering of all medications, formulary changes and potentially higher premiums for the plans.
In addition to the price cap, starting in 2025 the law requires a Smoothing provision for part D plans to provide enrollees the option to pay their out-of-pocket prescription drug costs in monthly installments if the annual cost of a prescription is over $500. You must opt in for this benefit and you may be able to opt in as soon as late December, or you can ask at the pharmacy or your drug plan after January 1, 2025.
Plan designs for 2025 will be released in September and I urge you to watch out for your Annual Notice of Change that your drug company will send out so you know what the impact will be for you. It will also be on the plan website and if you get materials electronically, in your portal. This will have information on your new premium and any formulary changes to your plan.
We will be able to see all the plans by October 1st and will be able to better advise you at that time when we are able to run comparisons for our clients.
Open enrollment runs from October 15 to December 7th and that is your opportunity to change to a different Part D or Advantage plan for 2025.
If you have any additional questions, contact our team today!
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