By: Allen Pinn, Coordinator, Policy 

Medicare Open Enrollment for 2025, which begins today and ends December 7, is an opportunity for Medicare enrollees to choose a new plan under Medicare Advantage, Medicare Part D, or traditional Medicare. Individuals who choose a new plan will see changes to their coverage beginning January 1, 2025.  

This year’s Open Enrollment is marked by significant changes from the recent prescription drug pricing law. Starting in 2025, multiple aspects of the legislation will go into effect for millions of Medicare recipients including the $2000 annual limit on out-of-pocket drug costs and the Medicare Prescription Payment Plan. 

To help Medicare beneficiaries make sense of these changes, the National Health Council (NHC) has created educational content under its NHC Trusted Messengers program. The resources are intended to help people evaluate their current plan, learn about factors to consider when purchasing a new plan, and determine if the payment plan is right for them.  

NHC resources include: 

• • An explainer video to announce changes to Medicare and encourage beneficiaries and families to explore their options 
  • Infographic/pocket card for beneficiaries, families, and providers to reference for navigation of the changes 
  • Sample social media posts and graphics

As Thanksgiving approached, families gathering for the holiday should use the time to evaluate their options. To help facilitate these conversations, the NHC will release additional materials such as: 

• •  Choose-Your-Own-Pathway interactive graphic 
  • A longer explainer video offering more details about major Medicare changes 
  • Additional educational infographics for at-a-glance information

To access these resources on Medicare’s new benefits, click here.  

This page also includes links to resources developed by NHC members, Medicare, and other organizations.  

More on the $2000 out-of-pocket limit 
Effective January 2025, Medicare Advantage and Medicare Part D will enact a $2000-a-year out-of-pocket limit on prescription drugs. This is the first time in Medicare’s history that a cap will be put in place for enrollees, which will be a tremendous benefit to people with high drug costs, such as those with chronic diseases and disabilities. Included in the $2000 limit are coinsurance, copayments, and deductibles for all Medicare covered drugs. The $2000 limit will not be applied to premiums nor drugs outside of Medicare plans. The out-of-pocket limit will increase annually based on the growth rate of per capita Part D costs. 

More on the Medicare Prescription Payment Plan 
The new Medicare Prescription Payment Plan will take effect also next year. The plan will allow Medicare enrollees to spread out-of-pocket drug costs over a calendar year (January–December). All Medicare drug plans will offer this voluntary payment plan option. The payment plan will be most useful for Medicare beneficiaries who are prescribed medications with high out-of-pocket costs. 

Importantly, beneficiaries who want to participate in this program must opt-in. They can do this through their insurance plan during open enrollment or anytime next year. However, people who opt in earlier in the year are likely to benefit the most. It is also possible that payments across the calendar year may vary depending on what time of year a patient fills their prescription and whether they add additional prescriptions throughout the year. For instance, if a beneficiary adds a medication to their regimen, unless they have hit the $2000 limit, payments may increase towards the end of the year because there are fewer months to make payments within the calendar year. Finally, if an enrollee chooses to participate in the payment plan, they will continue to pay their plan premium, and their monthly payments for their drugs will be billed by their Medicare health or drug plan instead of paying for medication through their pharmacy. 

To learn more about Open Enrollment, visit Medicare.gov.