Medicare Updates:
Part D Changes and Smoothing Benefit for Medicare Beneficiaries Starting Jan 1, 2025: What Providers Should Know:
Two new Medicare benefits starting 1/1/25, so read below to be aware:
1. Smoothing benefit: allows Medicare beneficiaries to spread their out-of-pocket costs for drugs over the year
2. Out of Pocket Cap is $2K, not $8K
3. Reminder: $35 Copay Cap on Insulin (started in 2023)
Medicare Part D changes for beneficiaries, starting Jan 1, 2025 include:
· Maximum Out-of-Pocket Cap of $2K for Prescription Drugs (Starting 1/1/25, Medicare beneficiaries OOP Prescription Drug spend is capped at $2K per year, much lower than the current $8K OOP cap in 2024)
· Smoothing: beneficiaries can voluntarily “opt in” to with their plan that allows them to smooth their drug costs over the course of the year, rather than pay the cost upfront all at once. While it may be helpful to those who have $600 drug spend or more, it is important to know it is not automatic and requires the beneficiary to act at any time during the year but it can start as early as Jan 1st.
· A reminder of additional benefits implemented over the past 2 years:
o Insulin cap for insulin ($35/ mo.) -effective since 1/1/23
o $0 cost sharing for recommended vaccines -effective since 1/1/23
o Expansion of Low-income subsidy for those with incomes up to 150% of FPL ($1,923/ mo. for individuals or $2,575/ mo. for couples); -effective since 1/1/24