2025 Medicare Part D changes

Those who are already enrolled in Original Medicare (Part A and Part B) may choose to enroll in prescription drug coverage through Medicare Part D, while Medicare Advantage Plans (Part C) typically offer prescription drug benefits to people who choose to enroll in their plan instead of Original Medicare with a standalone Part D plan.

Like other health insurance plans, changes to the Medicare program occur from year to year. If you have Medicare in 2025, it’s important to understand the drug coverage changes that went into effect for this year.

Changes to Medicare Part D plans in 2025

Aside from formulary changes, which can occur at any point throughout the year, you can expect to see several changes to your drug coverage plans in 2025.

1. No more donut hole

As of Jan. 1, 2025, the Medicare coverage gap (also known as the “donut hole”) was eliminated. Medicare prescription drug plans now have three coverage phases instead of four: deductible, initial coverage, and catastrophic coverage.

2. Plan availability

In 2025, the average Medicare consumer will have access to approximately 48 Medicare plans with drug coverage, including 14 Part D stand-alone plans (PDPs) and 34 Medicare Advantage drug plans (MA-PDs), according to KFF.

3. Monthly premiums

In 2025, there will be higher premiums on average for stand-alone Medicare Part D drug coverage. 

The national base premium is $36.78 for 2025, according to the Centers for Medicare and Medicaid Services. This is an increase from $34.70 in 2024. 

The average monthly premium for Medicare Advantage plans in 2025 will be $17 per month, compared to $18.50 in 2024. 

Part D premiums vary by plan.

4. Cost-sharing structure 

Cost-sharing is the portion of Medicare costs that you’re required to pay out of your own pocket. This includes deductibles, coinsurance, and copayments. Several changes were made to the cost-sharing structure for 2024.

The standard deductible increased 2025 by $45 from $545 to $590.

Initial coverage limits decreased by $3,030, from $5,030 to $2,000. This means that you’ll pay your plan’s copay or coinsurance rate until you and your plan have spent $2,000 on covered drugs.

After spending $2,000, you’ll enter the catastrophic coverage stage and will no longer have any cost-sharing for your covered medications.

RELATED: Important Medicare donut hole update

5. Medicare Extra Help

The Medicare Extra Help program is a low-income subsidy that helps eligible consumers pay for certain Medicare Part D costs. The resource limits for determining Medicare Extra Help eligibility are higher in 2025 compared to 2024. For those who receive the full subsidy, the resource limit increased to $17,600 from $17,220 for single individuals. For married couples, the limit increased to $35,130 from $34,360.

For those enrolled in Medicare Extra Help, the maximum copayment for generic drugs increased from $4.50 in 2024 to $4.90 in 2025. The maximum copayment below the out-of-pocket threshold for brand-name drugs increased from $11.20 to $12.15. 

RELATED: Who qualifies for Medicare Extra Help?

How to find the best Medicare Part D drug plan

“Although all Medicare drug plans meet a standard level of coverage, the medications, costs, and pharmacies you can use will vary,” says Ashley Woodcox, executive director of Brookdale Senior Living. “It’s important to compare plan options and choose one that works best for your specific needs.”

1. Choose between a stand-alone Part D plan or Medicare Advantage prescription drug coverage. 

Stand-alone prescription drug plans (PDPs) are available to those already enrolled in Original Medicare (Part A or B). As an alternative, people with Medicare also have the option to enroll in a Medicare Advantage plan (Part C) with Part D drug coverage included. Medicare Advantage plans provide Medicare coverage through private companies instead of the federal government. 

In 2025, there will be more Medicare Advantage plans with Part D coverage than stand-alone plans; however, Medicare Advantage plans often have more network restrictions than Original Medicare.

RELATED: Medicare Part D vs. Medicare Advantage

2. Compare several plans and providers.

Every plan is different and will vary in terms of cost, coverage, and network providers. Examples of popular providers include Kaiser, Humana, United Healthcare, and BlueCross BlueShield. To compare plans, visit medicare.gov to use the Plan Finder tool or call 1-800-MEDICARE (1-00-633-4227). TTY users can call 1-877-486-2048. 

3. Compare the plans’ formularies and find one with your medication on a lower drug tier.

While your medication may be covered by several plans, it’s important to know which tier your medication is on. For example, your medicine may be on one plan’s lowest tier, so you’ll pay the lowest amount, while that same drug may be on the highest tier for another plan, so you’ll pay the highest amount. You’ll also want to note formulary restrictions, such as preferred pharmacy networks and prior authorization, and then choose a plan with as few restrictions as possible.

RELATED: What is a Medicare formulary?

4. Compare plans annually to ensure you’re enrolled in the best drug plan for your prescription needs.

Drug formularies can change their covered drugs throughout the year. Part D enrollees have the option to change their plan every year during the annual Part D Open Enrollment Period, which occurs from Oct. 15 to Dec. 7. 

If you don’t wish to change plans during the Medicare Open Enrollment Period, your current Medicare coverage will automatically continue into the next year unless your plan is discontinued. If your plan is discontinued, you’ll be automatically facilitated into a benchmark Part D plan unless you choose a new one. 

5. If you don’t want Part D, keep records of creditable drug coverage.

While Medicare Part D coverage isn’t required and may not seem necessary to some, there may be a late enrollment penalty if you decide not to elect coverage. This penalty applies to those who aren’t enrolled in Part D or other creditable drug coverage for a continuous period of 63 days or more after their Initial Enrollment Period ends. For this reason, many Medicare enrollees choose to enroll in Medicare Part D prescription drug coverage as soon as they become eligible to avoid the potential for future penalties. If you qualify for Extra Help, it’ll eliminate this penalty.

6. Take advantage of additional savings programs.

It’s important to note that although Medicare Part D helps you save money on prescription drugs, it’s not free. The specific out-of-pocket costs vary based on the plan chosen. Each plan has its own yearly deductible, monthly premium, coinsurance, and/or copayment. However, there are additional savings options to help further reduce the costs associated with your plan. Some examples of these savings options include:

Medicare Extra Help: Low-income Medicare beneficiaries with limited resources can get assistance through Extra Help. This program helps cover costs associated with Medicare drug plans, such as yearly deductibles, monthly premiums, and coinsurance. 

SingleCare: Compare your Medicare copays to SingleCare discounts before filling your prescriptions. This could help you save up to 80% on your medications at over 35,000 nationwide pharmacies. Get your free prescription discount card here.

Note: If you have a Medigap policy (Medicare supplement plan), it will not help subsidize Part D costs. It only applies to Part A and B costs.

Lea este artículo en español aquí.