What's different for prescription drug plans in 2025?
The Inflation Reduction Act (IRA) is a federal law that makes improvements to the Medicare program. Among other things, the IRA will expand Medicare benefits and help reduce Medicare members’ out-of-pocket costs for prescription drugs.
The coverage gap, known as the donut hole will be eliminated.
In 2025, there are only three Part D prescription drug coverage stages: Deductible (depending on your plan), Initial Coverage, and Catastrophic Coverage.
In 2024, Medicare members were required to hit an $8,000 out-of-pocket maximum on prescription drug expenses before entering the Catastrophic Coverage stage. In 2025, this out-of-pocket maximum will be $2,000.
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Dorothy D. Steed, MSLD, CCS, CDIP, COC, CPCO, CPUM, CPUR, CPHM, CPMA, ACS-OP, CCS-P, RCC, RMC, CEMC, CPC-I, CFPC, PCS, FCS, CRCR, CICA, CPAR is an Independent Healthcare Consultant and Educator. She has served as a Medicare specialist and a physician audit supervisor for hospital systems with 49 years of experience in healthcare. She is an instructor at a state technical college in Georgia and provides auditing & training in both facility and physician services. She is credentialed in medical coding, medical billing, medical auditing, utilization management, healthcare management, healthcare compliance, clinical documentation improvement, revenue cycle, and patient accounts. Additionally, she has participated in multiple healthcare audits and investigations for both plaintiff and defendant.
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