Medicare Changes In 2024, 2025 Affect Prescriptions, Vaccines And More


Medicare beneficiaries need to know the changes taking place in in 2024 and 2025.

The changes begin with the inflation adjustments for various Medicare features.

The monthly basic Part B Medicare premium increased by $9.80 (or 5.94%) to $174.70 on January 1. The annual Part B deductible increased by $14 to $240.

The additional Part B premiums paid by higher-income beneficiaries under the Medicare premium surtax (also known as IRMAA) rose by about 8%. The maximum total monthly premium is $594.00. That top premium will apply to individuals who had adjusted gross incomes greater than $500,000 in 2022 and married couples whose adjusted gross incomes exceeded $750,000. (There’s a two-year lag between when income was earned and when it causes higher Medicare premiums.)

There are lower Medicare surtaxes at lower income levels, with the surtax beginning for individuals with adjusted gross incomes exceeding $103,000 and married couples with adjusted gross incomes exceeding $206,000.

Higher-income beneficiaries also pay a surtax on their Part D prescription drug premiums, with the maximum monthly surtax being $81.00 at the same income levels as the Part B surtax.

Another important change is in the out-of-pocket cost cap on “catastrophic coverage” under Part D prescription drug policies.

Congress is phasing out the famous coverage gap, or doughnut hole, for those with high prescription drug expenses.

To review, in 2023 a beneficiary was responsible for up to $7,400 in out-of-pocket prescription drug expenses before catastrophic coverage kicked in. After that, the beneficiary in the catastrophic coverage range paid 5% of all subsequent prescription drug expenses.

The 5% copay is eliminated for those in the catastrophic coverage range in 2024, and the out-of-pocket amount to reach catastrophic coverage is $8,000. In 2025, the catastrophic coverage range will be eliminated, and Medicare beneficiaries with Part D prescription plans will pay a maximum of $2,000 out-of-pocket for covered prescription expenses.

The expansion of covered telehealth medical care is extended through at least the end of 2024. The Centers for Medicare and Medicaid expanded telehealth coverage during the pandemic, but that was due to expire with the end of the pandemic’s emergency status. The Consolidated Appropriation Act extended the expanded coverage through the end of 2024.

After that, unless Congress acts or CMM changes it policy, telehealth will return to the pre-pandemic restricted coverage rules.

The expanded vaccine coverage that began in 2023 continues.

Vaccines that are recommended by the Advisory Committee on Immunization Practices for your age group are covered without copays, whether you are covered by Part B or Part D. Additional vaccines might be covered if the committee recommends them in your circumstances.

There’s a maximum copay of $35 for 30-day supplies of insulin. The $35 cap applies even when you haven’t reached any deductible under your plan.

But the cap applies only if the type of insulin you take is listed among your plan’s covered drugs, known as the formulary. Also, the $35 cap doesn’t apply to diabetes-management drugs that either contain no insulin or combine insulin with other ingredients.

Another change is the date when coverage begins for those who sign up or make changes during the annual general enrollment period.

Most people sign up for Medicare during their initial enrollment period, which usually is the seven months that run from the three months before and three months after they turn 65. They then make any coverage changes during annual open enrollment, which runs from October 15 through December 7.

Lesser known is the annual general enrollment period from January 1 through March 31. This enrollment period is for those who missed their initial enrollment period or who are enrolled but want to make one of several changes allowed during the general enrollment period.

In the past, any enrollment or changes during the annual general enrollment period didn’t take effect until July 1. In rules that took effect in 2023, changes made during the general enrollment period take effect on the first day of the month following the month the enrollment or change is completed.

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