Discovering That You Have a Prescription Drug Deductible in 2025?
This year, significant changes to Medicare Part D Prescription Drug Coverage resulting from the Inflation Reduction Act went into effect (for more info, check out our last post). Consequently, almost all Medicare beneficiaries experienced some disruptions to their prescription drug benefits (e.g., deductibles, copays, coinsurance, tiers, formularies, etc.) in 2025.
Many Medicare beneficiaries are unfortunately discovering these changes the hard way, via sticker shock at the pharmacy when refilling their prescriptions for the first time in 2025. One major change many are encountering is the inclusion of a new prescription drug deductible with their plan. Many beneficiaries who previously did not have to worry about a deductible now surprisingly find themselves facing one this year for the first time.
If you’re one of those folks discovering that you now have a prescription drug deductible and want to learn more, check out this short video courtesy of United Healthcare. It does a good job of efficiently explaining what you need to know about 2025 Prescription Drug Deductibles.
What You Need to Know About 2025 Medicare Prescription Drug Deductibles
Surprised By a Big Increase in The Cost of One Or More of Your Brand Medications?
In another case of sticker shock at the pharmacy, some surprised folks are reporting higher costs when refilling their brand medications for the first time in 2025 (Tier 3 medications, in particular). “Why the increase?”
This year, many plans have changed the Tier 3 benefit from a flat Copay (e.g., $47) to Co-insurance (e.g., 24% of the cost of the drug). Changes like this can have a significant impact on what someone pays out-of-pocket for their prescription each month (or, in some cases, every three months).
To illustrate, let’s consider the impact of copay vs co-insurance on the brand drug Xarelto, a blood thinner. Xarelto is commonly covered by most Medicare plans as a Tier 3 Preferred Brand. Let’s say the average total cost of Xarelto is $548. And in 2024, you paid a copay of $47 for a one-month supply. Then, in 2025, your plan’s Tier 3 coverage changed from a $47 copay to 24% co-insurance for a one-month supply. And just like that, your monthly cost for Xarelto increases from $47 in December to $131.52 ($548 actual drug cost x 24% coinsurance) in January, a difference of $84.52.
On the plus side, the maximum out-of-pocket cost for Medicare prescription drugs in 2025 is $2,000. This represents a considerable decrease from the 2024 out-of-pocket limit of $8,000.
Planning to Travel Outside the U.S. and Wondering About Your Coverage?
Here’s a tip: If you are traveling outside the U.S., you may want to consider buying specialized travel medical insurance regardless of your Medicare coverage. Travel medical insurance is separate from customary health insurance.
With a few exceptions, Medicare generally does not cover healthcare services when traveling outside the country. Some Supplement and Advantage plans cover a modicum of travel emergency care outside the country.
Here are some things you may want to know: U.S. territories such as Puerto Rico and Guam are included in the U.S. for Medicare purposes. Medicare drug plans don’t cover medications purchased outside the United States.
You can purchase travel medical coverage for the duration of the time you are out of the country. Specialty carriers include the likes of GeoBlue, International Medical Group, and others.
Fact Sheet: Medicare Coverage Outside the United States
https://www.medicare.gov/publications/11037-medicare-coverage-outside-the-united-states.pdf
What About Medicare Premium-related Appeals and Troubleshooting?
Think your Medicare Part B premium is too high? If you’re paying extra based on income or facing a late enrollment penalty, you can appeal to Social Security. For any Part D related late-enrollment penalties, appeal directly to Medicare.
If there are specific topics you’d like us to address in future issues please drop us a line at 65plus@bbginc.net with your suggestions.