Your Medicare … with Cheri Brown

Great news for Medicare beneficiaries: The Donut Hole is disappearing

If you’re on Medicare and have prescription drug coverage, you’re in for some positive changes in 2025. The dreaded “Donut Hole,” where you had to pay a significant portion of your medication costs, is finally being eliminated!

Here’s what’s changing:

• Goodbye Donut Hole: The confusing four-phase system is simplified into three phases. You’ll no longer face a gap in coverage where you pay 25 percent of medication costs.
• Capped Copays: Out-of-pocket expenses for covered medications are capped at $2,000 per year. This provides peace of mind and helps with budgeting, as you’ll know the most you’ll pay.
• Flexible Payments: Even better, you now have the option to spread your copays out over 12 months in equal payments. This translates to a manageable monthly cost, the most you can pay is $166.66 per month for medications.

What to expect:

While this is great news, some changes might occur as companies adjust to the new regulations. Be aware of these possibilities:

• Increased plan costs: Insurance companies may raise premiums, and co-payments to offset higher costs associated with eliminating the Donut Hole.
• Changes to formularies: Insurance companies may change their formularies to offset the higher costs.
• Broker commission changes: Some companies may reduce or eliminate commissions to brokers for selling their Part D plans. WellCare announced their elimination in August.

Stay informed and review your plan:

• Open enrollment period: The time to review and change your Medicare Part D or Medicare Advantage plan coverage is from Oct. 15 to Dec. 7.
• Plan details available: Earlier this month is when insurance companies post their updated 2025 plans on their websites and Medicare.gov.

Take action:

This year, carefully reviewing your medications and Medicare plan is crucial. With the changes, a different plan might be more suitable for your needs. Don’t hesitate to reach out to a local insurance broker or Sourcewise for assistance navigating the options during the open enrollment period.

Cheri Brown has 16 years of experience in the Medicare industry. She works, volunteers and lives in Morgan Hill. You can contact her at [email protected].