If you’re enrolled in Medicare, it’s important to remember Medicare Open Enrollment runs from Oct. 15 through Dec. 7 each year. This is the time for people with Medicare to compare their prescription drug and health coverage options for the upcoming year.
New This Year
The new prescription drug law is lowering out-of-pocket costs on covered prescriptions. New in 2025, all Medicare plans will include a $2,000 annual cap on what you pay out-of-pocket for prescription drugs under Medicare Part D. The cap only applies to drugs that are covered by your plan, so it’s more important than ever to review your plan options to make sure your drugs are covered. That means you will not pay more than $2,000 in 2025 on prescription drugs covered under Medicare prescription drug coverage – that includes expensive prescription drugs to treat cancer, chronic illnesses and more.
This is in addition to improvements already in effect due to the prescription drug law including a $35 cap on a month’s supply of each covered insulin product – and no out-of-pocket costs for recommended adult vaccines covered under Part D, including the shingles vaccine.
Also starting in 2025, you can choose to spread your out-of-pocket drug costs across the calendar year instead of paying all at once at the pharmacy. It’s called the Medicare Prescription Payment Plan. You can opt in with your plan in advance of Jan. 1 and throughout 2025.
How to Compare Prescription Drug and Health Coverage Options
Medicare.gov is the official source for information about Medicare and Open Enrollment. Start here to get unbiased information to find the type of coverage that best meets your needs.
Comparing prescription drug and health coverage options is easy at Medicare.gov. Get started by clicking on “Find Plans.” Then enter your ZIP code, current prescriptions and favorite pharmacies. You will see a side-by-side comparison of the total cost for all the plans in your area, including the premium and how much you’ll pay for your prescriptions. You’ll also be able to see what plans cover your prescriptions and whether some plans offer extra benefits. If you are happy with your current choice, you don’t have to do anything. If you choose a new option for 2025, you can enroll on Mediare.gov.
Before you enroll in a plan, consider this advice:
- Check if your health care providers are in a plan’s network.
- Check if your prescriptions are included on a plan’s formulary and if the plan works with your pharmacy.
- Review a plan’s estimated total costs to you, including deductible and other out-of-pocket costs. Remember low monthly premiums may not always be the best overall value for your specific needs.
- Check if Medicare Advantage plans offer extra benefits, like vision, hearing or dental coverage, if you need these services.
- Understand that you may need to get approval from the plan before it will cover certain services or supplies.
- Check your plan’s Star Rating to see how it performs on quality, customer service and more.
Medicare Can Help
To compare options and find the best coverage to fit your needs:
- Visit Medicare.gov and conduct side-by-side comparisons of costs and coverage.
- Call 1-800-MEDICARE. Help is available 24 hours a day, including weekends.
- Access personalized health insurance counseling in your community at no cost, available from your State Health Insurance Assistance Program (SHIP). Visit shiphelp.org or call 1-800-MEDICARE for locations near you.
Information provided by the U.S. Department of Health & Human Services.
