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Important Medicare Changes in 2025

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The Inflation Reduction Act of 2022 included several ways to manage your costs for Medicare Part D drugs:

  • In 2025, $2000 is the total maximum OOP cost patients will pay for their covered Part D drugs. This includes their annual deductible.
  • In 2025, patients can choose to spread out their out-of-pocket (OOP) costs over the course of the year with no additional fees or interest, by signing up for the Medicare Prescription Payment Plan.
  • “Extra Help” benefits were expanded in 2024 to help people with limited income and resources pay for their prescription drugs.
The Medicare Prescription Payment PlanWhat It Is

The Medicare Prescription Payment Plan offers patients the choice to pay OOP drug costs in monthly payments, instead of all at once at the pharmacy!

How it Works

Patients can sign up during open enrollment, or anytime during the plan year

The plan allows you to spread OOP costs over the rest of the year, rather than pay them all at once

Patients pay $0 to the pharmacy and will instead be billed monthly by their Part D drug plan

Patients typically need to opt-into the payment plan before picking up their prescription.

Who It May Be Most Helpful For

While the program is available to all patients with Medicare prescription drug coverage, the patients who are most likely to benefit from the program include those who expect high prescription drug costs earlier in the year. Signing up for the payment plan can spread those costs out throughout the year, allowing patients to pay smaller amounts each month.

How to Opt-In

All patients can opt-into the Prescription Payment Plan directly through their Part D or Part C Medicare Advantage plan during open enrollment or at any time during the plan year.

There are three main ways someone can sign up:

  • Phone: Call the Medicare Part D Prescription Drug Plan, or Part C Medicare Advantage plan directly
  • Paper Request: Fill out a paper form from their plan
  • Online: Their plan’s website may have an online form/portal to sign up
Example Medicare Part D Patient OOP Costs:Bob takes a medicine that costs him $600 each time he picks it up from the pharmacy

2025

First Fill in January

First Fill in July

Without Payment Plan

With Payment Plan

Without Payment Plan

With Payment Plan

January

$600

$167

--

--

February

$600

$94

--

--

March

$600

$154

--

--

April

$200

$176

--

--

May

--

$176

--

--

June

--

$176

--

--

July

--

$176

$600

$333

August

--

$176

$600

$173

September

--

$176

$600

$323

October

--

$176

$200

$200

November

--

$176

--

$485

December

--

$176

--

$485

Total

$2,000

2025

First Fill in January

With Payment Plan

Without Payment Plan

January

$600

$167

February

$600

$94

March

$600

$154

April

$200

$176

May

--

$176

June

--

$176

July

--

$176

August

--

$176

September

--

$176

Octomber

--

$176

November

--

$176

December

--

$176

Total

$2,000

2025

First Fill in July

With Payment Plan

Without Payment Plan

January

--

--

Febuary

--

--

March

--

--

April

--

--

May

--

--

June

--

--

July

$600

$333

August

$600

$173

September

$600

$323

Octomber

$200

$200

November

--

$485

December

--

$485

Total

$2,000

Please note that a patient’s monthly payments will vary depending on their mix of drugs and the month in which drugs are filled, but total OOP costs for the year will not be more than $2,000. This is simply an example of the payment plan and does not take into account potentially variable deductibles, coinsurances, and copays.

Extra Help Benefits for Part D in 2025

Low-Income Subsidy (LIS), or Extra Help, helps people with limited income and resources to lower or cut Part D costs:

$0

Drug Plan Premium

$0

Annual deductible

$12.15

Copay for brand-name drug & $4.90 copay for generic drugs

You will get Extra Help automatically if you get:
  • Full Medicaid coverage
  • Help with your Medicare Part B premiums through a Medicare Savings Program
  • Supplemental Security Income (SSI) benefits from the Social Security Administration
If you don’t automatically get Extra Help, you can apply for it through:Where to Get Additional Support
Prescription Payment PlanMedicare

Medicare.gov/prescription-payment-plan, or call 1-800-MEDICARE (1-800-633-4227)

Part D or Medicare Advantage Plan

Patients can visit their plan’s website or call them directly.

Extra Help Benefits for Part D in 2025Social Security Administration

Visit ssa.gov/extrahelp for more information on if you qualify for Extra Help and how to apply. You can also apply over the phone or request an application by calling Social Security at 1-800-325-0778

MyHealthcareFinances: Picking a Medicare PlanTips for Picking a Medicare Plan

https://interactive.digitalpfizer.com/tips-for-picking-a-medicare-plan-micro-module/index.html

Medicare, Medicaid, and Other Government Health Insurance

https://interactive.digitalpfizer.com/medicare-medicaid-and-other-healthcare-programs-micro-module/index.html

State Health Insurance Assistance Program (SHIP)

For help with Medicare, contact SHIP

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Disclaimer: The information on this site is intended for U.S. residents only and is provided purely for educational purposes. Health, legal, regulatory, insurance, or financial related-information provided here is not comprehensive and is not intended to provide individual guidance or replace discussions with a healthcare provider, attorney, or other experts. All decisions must be made with your advisers considering your unique situation. © Triage Cancer & Pfizer Inc. 2025

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