By Jose Juarez, guest columnist

Navigating the complexities of healthcare can be overwhelming, especially when managing your health, budget and peace of mind. The recent changes to Medicare Part D, the prescription drug coverage program, come after not being changed in nearly 20 years. So it’s important to review your current plans and make sure you don’t end up paying more.

Having worked with the elderly for many years, I understand how important it is to have reliable information to make decisions. Before we tackle 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 bigger picture of Medicare:

• Medicare Part A: This part covers hospital stays, skilled nursing facilities, hospice care, and some home health services. Most people do not 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, lab tests, and medical equipment such as walkers and wheelchairs. Most beneficiaries pay a monthly premium for Part B, which is based on their income.
• Medicare Part C (Advantage Medicare): 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 such as vision, dental, and hearing coverage.
• Medicare Part D: Part D is the part of Medicare that helps cover the costs of prescription drugs. It is offered by private insurance companies and is available to anyone with Medicare. This is the part that is subject to important updates that may have a significant impact on prescription drug costs.
• The recent changes to Medicare Part D are part of an ongoing effort to make prescription drugs more accessible and affordable. These updates are meant to ease the financial burden on older people and ensure that medicines remain within reach.

Below are the main changes to remember about Medicare Part D.

Limiting out-of-pocket costs

This is one of the most anticipated changes as it helps reduce the financial stress of high drug costs, especially for those who take multiple prescriptions or need expensive drugs. You’ll no longer face unlimited out-of-pocket costs for drugs once you reach the catastrophic coverage phase—out-of-pocket expenses will be capped at about $2,000 per year. As a result, this could lead to higher costs for prescription drug plans, which is why evaluating your current coverage is so important.

Medicare drug price negotiations

For the first time, Medicare will be able to negotiate the prices of 15 high-priced drugs directly with manufacturers. These negotiations will focus primarily on drugs that are commonly used by Medicare beneficiaries and have no generic or comparable alternatives. The goal is to reduce the cost of these drugs, potentially saving hundreds or even thousands of dollars a year.

Eliminating the “doughnut hole” coverage gap.

The Medicare “doughnut 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 phase of coverage will extend until your costs reach the $2,000 annual cap. After that, in the catastrophic phase, you’ll pay $0 for covered drugs (on the plan’s formulary).

The new deductibility for medicines

Some plans may add a drug deductible of up to $590. In addition, monthly premium increases will be capped at about $2 to help manage health care costs while maintaining access to needed drugs.

Changes to drug formulary and levels

High-end drugs may come with increased costs and higher deductibles. It’s important to check your plan’s formulary to understand any changes to your drug coverage, because drugs that aren’t on the formulary won’t count toward the $2,000 out-of-pocket maximum.

Other changes

There may be a reduction in benefits, so review the 2025 Summary of Benefits for future changes to your plan.

Certain plans, such as UHC’s $42 monthly PPO and PPO Alignment 007, will no longer be available in 2025, and beneficiaries will automatically opt out of traditional Medicare. If you are affected, 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 1st. If you want to continue receiving care through MemorialCare, contact me for help navigating your options.

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

Jose Juarez is a Medicare Education Specialist for MemorialCare.