Medicare Part D will see significant changes in 2025. The changes aim to lower prescription drug costs for enrollees and reduce federal spending. One notable change is a new $2,000 cap on out-of-pocket drug spending.
This cap is expected to greatly lower costs for Part D enrollees. However, it may present challenges for some plan sponsors, especially those offering stand-alone prescription drug plans (PDPs). To help limit annual premium growth, the Inflation Reduction Act has a provision that caps growth in the base beneficiary premium.
The cap is set at no more than 6% above the previous year’s amount. It’s important to note that this cap applies to the base premium, not the individual plan-level premiums charged by Part D sponsors.
Medicare drug cost cap upcoming
The Centers for Medicare & Medicaid Services (CMS) also aim to better reflect expected increases in plan liability for the redesigned Part D benefit. The goal is to enhance market stability. CMS has introduced measures to provide additional premium stabilization and protection against the risk of losses to stand-alone PDPs.
Reports from the Kaiser Family Foundation provide context for understanding Medicare Part D premiums in 2025 and changes in recent years. The impact of the Part D benefit redesign on the 2025 market is unknown. Individual plan premiums are likely to vary.
Premium increases at the plan level may be higher or lower than 6%, as they were for 2024. During the fall open enrollment period, all Part D enrollees will have the chance to evaluate their coverage. They can determine if there are lower-cost options that better meet their needs.
- TheStreet.”Medicare Part D Update for 2025″.
- OKDiario.”3 Major Medicare Changes: What You Need to Know Before Open Enrollment”.
- Fortune.”Why this year’s Medicare Annual Notice of Change will be vital reading for beneficiaries”.