By Jose Juarez, guest columnist

Navigating the complexities of healthcare can be overwhelming, especially when managing your health, your budget and your peace of mind. The recent changes to Medicare Part D, the prescription drug coverage program, come after not being changed in nearly 20 years. It is therefore important that you review your current plans and ensure that you do not have to pay more.

Having worked with older people for many years, I understand how essential it is to have reliable information when making decisions. Before diving into the recent updates, it’s helpful to review what each part of Medicare covers to give you a clearer understanding of how Part D fits into the broader Medicare framework:

• Medicare Part A: This part covers hospital stays, skilled nursing facilities, hospice care, and some home health services. Most people don’t pay a premium for Part A because they have worked and paid Medicare taxes throughout their careers.
• Medicare Part B: Part B covers doctor visits, outpatient services, preventive care, laboratory tests, and medical equipment like walkers and wheelchairs. Most beneficiaries pay a monthly premium for Part B, which is based on their income.
• Medicare Part C (Medicare Advantage): This is an alternative to Original Medicare (Parts A and B). Medicare Advantage plans are offered by private insurers and often include Part D (prescription drug coverage) as well as additional benefits like vision, dental and hearing coverage.
• Medicare Part D: Part D is the part of Medicare that helps cover the cost of prescription drugs. It is offered by private insurance companies and is available to anyone with Medicare. This is the part that is seeing significant updates that can have a huge impact on the cost of your prescription medications.
• Recent changes to Medicare Part D are part of an ongoing effort to make prescription drugs more affordable and accessible. These updates aim to ease the financial burden on seniors and ensure medications remain within reach.

Below are the main changes to note regarding Medicare Part D.

Capping personal expenses

This is one of the most anticipated changes because it helps reduce the financial stress of high drug costs, especially for those who take multiple prescriptions or need expensive medications. You will no longer face unlimited out-of-pocket costs for medications once you reach the catastrophic coverage phase – out-of-pocket costs will be capped at around $2,000 per year. As a result, this could result in higher costs for prescription drug plans. That’s why it’s so important to evaluate your current coverage.

Medicare drug price negotiations

For the first time, Medicare will be able to negotiate prices for 15 high-cost drugs directly with manufacturers. These negotiations will focus primarily on drugs commonly used by Medicare beneficiaries that do not have generic or comparable alternatives. The goal is to reduce the cost of these medications, which could save you hundreds or even thousands of dollars per year.

Eliminate the “donut hole” coverage gap

The Medicare “donut hole” coverage gap will be eliminated. Medicare Part D will now have a simplified three-phase benefit: a deductible phase, an initial coverage phase, and a catastrophic phase. The initial coverage phase will extend until your costs reach the annual cap of $2,000. Subsequently, in the catastrophic phase, you will pay $0 for covered medications (within the plan formulary).

Franchise for new drugs

Some plans may add a drug deductible of up to $590. Additionally, monthly premium increases will be limited to approximately $2 to help manage health care costs while maintaining access to necessary medications.

Changes to drug formulary and levels

Higher-level medications may result in higher costs and deductibles. It is important to check your plan formulary to understand any changes to your drug coverage, as off-formulary drugs will not count toward your $2,000 out-of-pocket maximum.

Other changes

There may be a reduction in benefits, so check the 2025 Benefit Summary for upcoming changes to your plan.

Some plans, such as UHC’s $42 monthly PPO and Alignment 007 PPO, will no longer be available in 2025, and beneficiaries will be automatically disenrolled from traditional Medicare. If you are concerned, call me at 877-599-5622 for guidance through this transition.

Some plans, including those from Alignment and Clever, may no longer be accepted by MemorialCare starting January 1. If you would like to continue receiving care through MemorialCare, contact me for help with your options.

Although choosing a Medicare plan can seem overwhelming, these updates are designed to make managing health care easier and more affordable, giving you the confidence to make the best decisions for your health and well-being -be financial. If you need help navigating these changes, please call 877-599-5622 or visit Memorialcare.org/MAEP24.

Jose Juarez is a Medicare Education Specialist for MemorialCare.