Big Changes to Medicare Drug Coverage

Medicare is rolling out new benefits in 2025. These include: 

• • • Capping Medicare beneficiaries’ total out-of-pocket costs per year at $2000 combined for all drugs, including copays and coinsurance;  
    • Giving everyone enrolled in Medicare the option to spread the costs of their medicines through each calendar year, split into monthly payments, instead of paying a large sum up front, through the Medicare Prescription Payment Plan; and 
    • Offering more financial assistance to help people afford their medicines through the Extra Help program.  

Some of these changes are automatic. Others will require people to enroll.

These new benefits coupled with other big changes may result in Medicare plans looking very different next year. Some plans might modify whether certain medications are covered and if there are additional requirements for coverage such as prior authorization. All Medicare beneficiaries and their families/caregivers should take time this fall to evaluate their options, even if they are happy with their current plan. 

This page includes resources from the National Health Council (NHC), Medicare, and trusted NHC member and partner organizations to help people navigate their options to access and afford their medications. 

Government Resources

• • CMS Resources – What’s the Medicare Prescription Payment Plan? | Medicare and Fact Sheet: Medicare Prescription Payment Plan (cms.gov)

NHC Member Resources

• • Alliance for Aging Research Video – Project LOOP (Lower Out-of-Pocket Costs in Medicare Part D Now) – Alliance for Aging Research
  • PAN Foundation – Understanding the Medicare Prescription Payment Plan – PAN Foundation
  • ALPHA-1 Foundation – New Medicare Prescription Payment Plan – A Patient’s Guide – Alpha-1 Foundation (alpha1.org)

Other Resources

• • Medicare Rights Center – Guidance on Inflation Reduction Act’s Medicare Prescription Payment Plan Released – Medicare Rights Center
  • CareFirst MA – Medicare Prescription Payment Plan | CareFirst BlueCross BlueShield Medicare