This content is sponsored by Astellas Pharma.
Two major changes to Medicare Part D are in effect for 2025 to help seniors manage their prescription drug expenses. Following action from Congress,聽聽now must cap enrollees鈥� out-of-pocket spending on covered prescription drugs at $2,000 a year. Part D beneficiaries also can spread or smooth their drug costs over a calendar year.
However, a by the Partnership to Fight Chronic Disease (PFCD) reveals that most seniors with Medicare prescription drug coverage remain unaware of these beneficial changes. The survey found that 74% of seniors say they鈥檇 heard little to no information about the Medicare Prescription Payment Plan 鈥� and nearly half (48%) say they鈥檝e heard nothing at all.
鈥淭hese results show that too many seniors are missing out on a program that could help them better manage their prescription drug expenses simply because they don鈥檛 know it exists,鈥� said Candace DeMatteis, policy director at PFCD, in accompanying the release of the poll.
A panel of experts assembled by 百花视频 and Federal News Network and sponsored by聽 recently discussed the implications of the new changes to Medicare and what advocacy organizations are doing help people stay informed about these updates.
Adina Lasser, director of public policy and government affairs with the Alliance for Aging Research, said advocacy groups are trying to make sure people know about critical changes that can affect their health care. Her organization compiled聽聽to explain the new facets.
Key Enhancements to Medicare Part D
Capping Out-of-Pocket Costs:聽All beneficiaries enrolled in Medicare Part D or Medicare Advantage prescription drug plans now pay no more than $ 2,000 per year out of pocket for their medications, including copays and coinsurance.
鈥淪moothing鈥� Costs Throughout the Year:聽Beneficiaries also have the option to enroll in the Medicare Prescription Payment Plan, which allows them to spread their annual medication costs into monthly installments. Enrollment is not automatic 鈥� beneficiaries must choose to opt in. They can do so at any time in the year by contacting their prescription drug plan.
For more information, check out these resources from the聽, the聽, and the聽.
As patient advocacy groups work with the government to help spread the word, Lasser noted聽 older adults aren鈥檛 the only ones who need to keep pace with the details. Those 聽who take care of parents and grandparents 聽should know about out-of-pocket prescription drug costs, too. 鈥淚t鈥檚 a complex system,鈥� Lasser said. 鈥淲herever we can find inroads to make that easier, I think, it鈥檚 important.鈥�
The National Health Council also added resources聽聽to help people navigate the changes, said Jennifer Dexter, vice president of policy with the National Health Council. Toni Gingerelli, policy and advocacy director for the National Alliance for Caregiving (NAC), emphasized聽the importance of such resources for caregivers聽as they plan and budgets more effectively to avoid upfront financial shocks.
鈥淚t鈥檚 important to review the plan every year because plans can change,鈥� said Julia Schreiber, program director for the Maryland State Health Insurance Assistance Program. She suggested that, as the year moves forward, people think not only about their medications but also where they are going to get their medications. That鈥檚 particularly important as the new option for monthly payments is available for beneficiaries to take advantage of outside the annual period of open enrollment.
Medicare drug cost cap will impact millions
In 2021, at least 4 million people paid more than $2,000 each for prescription drugs, Lasser said. The average was close to $3,300.That makes this new cap 鈥渞eally pretty life changing.鈥� Dexter said. She and others expect it will significantly impact peoples鈥� lives. 鈥淲hat鈥檚 really nice about that is you don鈥檛 have to enroll,鈥� Lasser said. 鈥淵ou honestly never really have to think about it. It鈥檚 just when you hit that $2,000 threshold, your expenses will end for the year.鈥�
Added Gingerelli: 鈥淲e always say at the National Alliance for Caregiving that caregiving hits you at moments when you least expect it. So it鈥檚 really important that people are aware of the changes that are happening.鈥�
Another major change? The聽聽lets people spread out their costs, an option commonly referred to as 鈥渟moothing.鈥� 鈥淲hat it does is it allows you to spread out your costs evenly every month over the course of the year,鈥� Lasser said. 鈥淵ou can enroll any time throughout the year. But if you enroll in July, you can only spread your costs over six months versus January 鈥� 12 months.鈥� For that reason, Lasser and others recommended enrolling in the Medicare Prescription Payment Plan early in the year. To enroll, beneficiaries must contact their Medicare Part D plan because it is not possible to sign up at the pharmacy counter. Experts suggest people enroll at least 24 hours before picking up their first prescription from the pharmacy.
Consider your 鈥渟moothing鈥� options
Dexter encouraged people to review their financial situation when considering whether to use the smoothing plan. Online tools can help estimate medication costs throughout the year, allowing beneficiaries and their caretakers to 鈥渁nticipate what those costs might be month to month 鈥� and see if it will benefit you.鈥�
Financial planning is one of the first things that caregivers take on with a loved one, 鈥渟o having more resources for caregivers, like the smoothing process 鈥� to be able to plan budgets more effectively and avoid upfront financial shocks 鈥� is really crucial,鈥� Gingerelli said. 鈥淲e want to make sure that people have the opportunity to opt in鈥� to the Medicare Prescription Payment Plan, she added. Gingerelli also noted that the plan is 鈥渁 great step forward to making sure that caregivers improve [people鈥檚] medication adherence.鈥�
Healthcare advocates for years have pointed out that many people don鈥檛 take their medication 鈥� or don鈥檛 take it as prescribed 鈥� because they feel they can鈥檛 afford the expense. Dexter reiterated that it is important to get the word out about payment options because there will be people who have trouble affording the $2,000 before the cap kicks in.
The success of these efforts to spread the word may be crucial to ensuring the program reaches those who could most benefit. The PFCD survey found that after receiving information about the program, nearly half (48%) of seniors who report spending more than $1,000 per year on prescription drugs say they would likely use it, highlighting the importance of education efforts.
“When [seniors] learn about the Medicare Prescription Payment Plan, they see its value,” DeMatteis added.
All the panelists said they are optimistic about the latest changes and believe they will make major differences in Americans鈥� health care. 鈥淭hese are things that we have fought for years and years to make happen, so to see them really happening and to be in this moment is significant,鈥� Dexter said.
More information about the Medicare Prescription Payment Plan is available on the聽鈥� website.聽Check out additional resources on the聽, 聽and view the detailed poll findings at .
