Please note: The following information obtained from available and related appropriate sources is provided for informational purposes only. The Cutaneous Lymphoma Foundation does not have an insurance or Medicare/Medicaid expert on staff and is unable to answer any questions regarding plans or changes. If needing assistance, contact your local State Health Insurance Program (SHIP) at https://www.shiphelp.org/ or if you signed up for coverage through a trusted advisor/broker, you can also contact them.
Each year during Medicare Open Enrollment, it is very important to review the Annual Notice of Change (ANOC) you should receive by the end of September from your current Medicare prescription plan. The Annual Notice of Change includes any changes in coverage, costs, provider networks, service area, and more that will be effective in January. If you don’t receive these important documents by the end of September, contact your plan. Because many changes are taking place starting January 1, 2025, it is very important to review the changes that should be detailed in the ANOC, as well as checking to see if your medications will still be in your plan's formulary in 2025. This is important to know since Open Enrollment takes place from October 15 - December 7, 2024 for plans starting on January 1, 2025, in case you find your current plan is no longer the best option for you.
There will be many changes, especially for Part D prescription coverage, starting in 2025.
Your out-of-pocket drug costs will be capped at $2,000 for medications that are covered by your Medicare prescription Part D plan formulary. Again, make sure your medications will still be in your plan's formulary in 2025. More details about the cap are in the resources below.
Also starting in 2025, a new optional Medicare Prescription Payment Plan (MP3) will be available to help you manage your out-of-pocket drug costs by spreading them across the calendar year (January–December). It doesn’t save you money or lower your drug costs, but this payment option might help you manage your expenses. This is optional, but you must be proactive if you would like to sign up for it. More details are in the resources below.
If you did not receive a Medicare & You 2025 Handbook in the mail, you can view it at https://www.medicare.gov/publications/10050-medicare-and-you.pdf. Page 2 briefly explains what is new and important with Medicare, in general for 2025, but also refers you to other pages in the Handbook for more details. Changes for 2025 are marked with a blue NEW. Please review the changes, but especially review the changes for your prescription drug coverage (Part D).
New Resources from Coalition of Skin Diseases
The Coalition of Skin Diseases (CSD), in partnership with the Medicare Access for Patients Rx (MAPRx) Coalition, created the following resources:
- Medicare Part D Prescription Drug Open Enrollment Guide https://skincoalition.org/resources/2025-medicare-prescription-drug-annual-open-enrollent-guide/
- Patient Guide https://skincoalition.org/resources/medicare-part-d-perscription-druc-coverage-patient-guide/
Congress recently made changes to the Medicare Part D prescription drug benefit. As a result, Part D prescription drug plans now cap out-of-pocket costs at $2,000 in 2025 for medications in your plan's formulary. (Out-of-pocket costs refer to the expenses you pay for medications. Also, please note that the medications covered in your plan's formulary can change every year.) After you reach the out-of-pocket cap for medications covered in your plan, you will pay $0 for your prescription drugs for the rest of the year.
You can now also opt into the Medicare Prescription Payment Plan (MPPP)—a new program that lets you spread out your payments for prescriptions over the year rather than paying the full cost when you pick up your prescriptions at the pharmacy. The MPPP may help you manage your drug costs by letting you spread them out over the course of the year into zero-interest monthly payments.
The above guides have information about the out-of-pocket cap and the MPPP, including links to resources and answers to frequently asked questions about how the changes to Part D will affect you. If you need help, please contact your State Health Insurance Assistance Program at https://www.shiphelp.org/
IMPORTANT! The following resources will help you learn more about the two major changes. It is not exhaustive and new resources may be added as we become aware of them. However, If all of this makes your head spin and you would like to get one-on-one free help, you can contact your local State Health Insurance Program (SHIP) at https://www.shiphelp.org/ or view the list by state starting on page 114 of the Medicare & Your 2025 Handbook. Call very soon since appointments will fill fast due to the changes that will be starting on January 1, 2025. If you signed up for coverage through a trusted advisor/broker, you can also contact them for possible assistance.
Resources:
Changes to Medicare for 2025 and Beyond: Important Information for the Rare Disease Community Ahead of Open Enrollment - shared from National Organization for Rare Disorders (NORD)
https://tinyurl.com/yvfw7hxt
2025 Medicare Changes & What They Mean for You - shared from National Psoriasis Foundation
https://tinyurl.com/2tv4tzxu
Medicare Plan Finder - shared from Medicare - A tool to compare Part D plans (be sure to expand or open any links or hyperlinks)
https://tinyurl.com/595vhpx5
What's the Medicare Prescription Payment Plan? - shared from Medicare
https://tinyurl.com/5n9bejsw
New Medicare Payment Prescription Payment Plan: A Patient's Guide - shared from Alliance for Patient Access (AfPA)
https://tinyurl.com/3cddpru8
Your Medicare Guide: Tackling Costs and Answering Your Questions - shared from CLL Society
https://tinyurl.com/2fbxy7bx
Medicare 101 Webinar (replay) - shared from Triage Cancer
https://vimeo.com/1013284874