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Medicare changes: What you need to know

Starting in 2025, Medicare Part D will change to help reduce healthcare costs for older adults on Medicare:

  • Elimination of the coverage gap, commonly referred to as the “donut hole.”
  • A newly defined standard Part D benefit design consisting of three phases.
  • Lower maximum out-of-pocket costs (MOOP).
Coverage phases

Beneficiaries will have 3 phases of coverage (reduced from 4 phases in prior years) with a maximum out-of-pocket spending limit of $2,000.

  • Phase 1: Annual Deductible

    Deductible up to $590 (if applicable to selected plan)

  • Phase 2: Initial Coverage

    25% co-insurance until reaching $2,000 (including deductible)

  • lockedPhase 3: Catastrophic Coverage

    No cost sharing for covered drugs

What counts toward the $2,000 maximum OOP spending limit:

Yearly deductible

Coinsurance

Copayments

What doesn't count toward the $2,000 maximum OOP spending limit:

Medicare Part D prescription drug plan premium

Pharmacy dispensing fee

What you pay for prescription drugs that aren’t covered

Better understand Medicare plan changes
It's important to review your Medicare plan annually before the Open Enrollment Period to ensure you have the coverage that's right for you. The Annual Notice of Change (ANOC) details upcoming changes in your current plan effective the following January. Plans are required to distribute it to their current Medicare members by September 30 or 15 days before the Open Enrollment Period begins.
If you haven't received your Annual Notice of Change by the end of September, reach out to your Medicare plan directly to request the document.
As you read through the letter, you’ll want to review any changes to the information below:
Coverage

Look for coverage additions and removals. Make sure services and medications you need are still covered, and review updated coverage terms.

  • Consider: Have my health needs changed, and is my coverage sufficient?
Cost (premiums, deductibles, copays)

Evaluate your total expenses, including premiums, deductibles, and copays. Pay close attention to the new out-of-pocket maximum, as it may impact your overall costs. Information about this maximum will be provided to help you understand its effect on your expenses.

  • Consider: Are my premiums changing or staying the same?
Drug formulary (covered drug list)

Make sure your medications are still covered, and check if they’ve moved to a different tier, which could affect the cost.

  • Consider: Are my medications still on the plan’s covered drug list? How has the drug formulary changed?
Provider and pharmacy network

Make sure your providers and hospitals are still in-network, and any specialists you see regularly are still covered. Preferred Network Pharmacies may help you save on money with low-cost copays.

  • Consider: Is my pharmacy in the plan’s network?
Need more information about Medicare?

Visit the official US government website for Medicare: Medicare.gov

References

1. https://www.cms.gov/newsroom/fact-sheets/draft-cy-2025-part-d-redesign-program-instructions-fact-sheet

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* No obligation to enroll. This ad is not from the government. It’s from HealthCompare, an Allstate Company, an insurance agency selling plans from many insurance companies. We do not offer every plan available in your area. Currently we represent 21 organizations which offer 52, 101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. Enrollment in plans depends on contract renewal. Enrollment in a plan may be limited to certain times of the year unless you qualify for a special election period, or you are in your Medicare Initial Period. Not all plans offer all benefits mentioned. Deductibles copay and coinsurance may apply.

HealthCompare, an Allstate company, is a licensed health insurance agency. It does not underwrite or administer health insurance policies. Customers interested in health insurance products will be assisted by a licensed insurance agent from HealthCompare, an Allstate Company.

† Sunday-Saturday 8 am-11 pm EST. HealthCompare, an Allstate Company, is a licensed insurance broker. No commissions are paid to Walgreens.

‡ Advice is free with no obligation to enroll and provided by independent licensed agents representing one or more plans. Licensed agents are not employees or agents of Walgreens, HealthCompare an Allstate Company, or any government agency.

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