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About Portland observer. (Portland, Or.) 1970-current | View Entire Issue (Oct. 23, 2024)
October 23, 2024 Page 7 Big Changes in Medicare Rx Costs in 2025 Two Significant Changes Have Been Made to the Prescription Drug Costs There are changes in Medicare Advantage Prescription Drug costs starting in 2025 that the Biden administration has suc- cessfully negotiated as part of the “Inflation reduction act”. $2,000 is the most you will pay for Medicare-covered prescriptions for the entire year, and the cum- bersome Coverage Gap (the Do- nut Hole) is being discontinued. Medicare Advantage plans, also called Medicare Part C, are one of the three choices for se- niors and persons on disability seeking to maintain healthcare coverage. Medicare Advantage plans are offered by private in- surance companies, and most often include additional bene- fits beyond Original Medicare, and the most accessible of the three choices for seniors seeking health care coverage. Medicare Advantage plans often include vision, dental, and prescription drug coverage. In 2025 two significant chang- es have been made to the pre- scription drug costs: 1: the cap of $2,000. This cap is also called the MOOP Maximum out of Pocket. 2: the convoluted Cov- erage Gap also called the Donut Hole will be discontinued. The New Prescription Drug Cap is designed to provide finan- cial relief to beneficiaries who are on fixed incomes and expensive medications, ensuring that they do not face financial hardship. Benefits of the $2,000 Cap: 1. Financial Protection: The primary benefit of the $2,000 cap is the financial protection it offers. Bene- ficiaries who require high- cost medications will no lon- ger have to worry as much about their prescription drug expenses exceeding this lim- it, providing some peace of mind and financial stability. 2. Increased Access to Medications: With the cap in place, more beneficiaries may be able to afford their prescribed medications, leading to better adherence to treatment plans and im- proved health outcomes. 3. Predictable Costs: The cap allows beneficiaries to better predict their annual The Essential Role of Current and Future Health Professionals Apply to the United Health Foundation Diversity in Health Care Scholarship Derek Ewell is a licensed insurance broker, with over 8 years of experience. healthcare expenses, making zation requirements. it easier to budget and plan 2. Compare Costs: for the future. Look beyond premiums Potential Challenges: and consider other out-of- While the $2,000 cap offers sig- pocket costs, such as co- nificant benefits, there are also payments, coinsurance, and potential challenges that need to deductibles. be addressed: 3. Consider Additional 1. Plan Premiums: In- Benefits: Evaluate the addi- surance companies can and tional benefits offered by the will adjust plan premiums plan, such as dental, vision, deductibles, copays and and wellness programs, to coinsurance to offset the determine their value to you. costs associated with the 4. Seek Professional Ad- $2000 cap. vice: Consult with a Medi- 2. Formulary Restric- care advisor or use resourc- tions: Some plans may have es like the Medicare Plan more restrictive formular- Finder to compare plans and ies, limiting the availability make an informed decision. of certain medications. Conclusion: 3. A d m i n i s t r a t i v e The introduction of a $2,000 Complexity: Implement- cap on out-of-pocket prescription ing and managing the cap drug costs in Medicare Advan- may introduce additional tage plans represents a significant administrative complexi- step towards making healthcare ties for both insurers and more affordable and accessible beneficiaries. for seniors. While there are po- To navigate these changes tential challenges, the overall Clear communication and sup- impact is expected to be positive port from insurance providers and the removal of the Donut and insurance agents will be cru- Hole will lead to more continuity cial to ensure a smooth transition. in the prescription drug process. Beneficiaries should verify that Beneficiaries like yourself their required medications are should take the time to review covered under their chosen plan. your plan options and choose the How to Choose the Right Plan: one that best meets your health- Given the changes, it is more care needs and financial situation. important than ever for bene- I hope this article provides a ficiaries to carefully evaluate comprehensive overview of the their Medicare Advantage plan changes in the Medicare Advan- options. Here are some tips for tage prescription drug cap. If you choosing the right plan: need any more details or have 1. Review Plan Formu- other questions, feel free to call laries: Ensure that the plan Derek Ewell, licensed insurance covers your necessary med- broker at 503-344-8505, or Email ications and check for any at DMEinsurance@gmail.com, restrictions or prior authori- www.derekinsures.com Experience shows that when patients receive care from health providers who speak their lan- guage or understand their cultur- al needs, they are more respon- sive and engaged. This can lead to better health outcomes, as patients feel safe and trust their health care providers. A young man, deeply con- nected to his Native Ameri- can heritage from a young age, spent part of his childhood on a reservation. There, he accessed medical care through the Indian Health Service and witnessed the positive impact of cultural- ly relevant care firsthand. After completing his undergraduate degree, he became an orthopedic scribe at a clinic near a Navajo reservation and is now pursuing a medical degree. A young woman, inspired by her mother’s journey from Haiti to America in 1992 and her ded- ication to caring for her grand- father with prostate cancer, de- cided to pursue a career in health care. Now studying to become a registered nurse, she is deter- mined to advance her career by focusing on maternal and infant health, areas where significant health disparities persist. Both are advancing their clin- ical careers with support from the United Health Foundation’s Diversity in Health Care Schol- arship program. Motivated by the desire to serve patients with similar backgrounds, they are committed to supporting their communities by providing cul- turally responsive care. Since the program launched in 2022, the United Health Foundation has provided schol- Anne Yau Senior Vice President arships to nearly 2,000 health professionals and students from diverse backgrounds. This ini- tiative is part of their commit- ment to making the health care system work better for everyone. Through the Diversity in Health Care Scholarship program, the United Health Foundation aims to support 10,000 current and fu- ture clinicians by 2033. The scholarship is available to historically underrepresent- ed health professionals, help- ing them advance their clinical degrees or credentials. Schol- ars come from various clinical fields, including nursing, mental health, physical therapy, dentist- ry, pharmacy, and medicine. The United Health Founda- tion’s Diversity in Health Care Scholarship program offers scholarships to current and as- piring health professionals from historically underrepresented backgrounds who aim to make a difference in health care. Com- mitted to expanding a diverse health care workforce, the Unit- ed Health Foundation provides scholarships to support the pro- fessionals. If you or someone you know is a health care professional looking to further advance their clinical degree or credentials, encourage them to apply for a $3,200 scholarship by visiting https://scholarshipamerica.org/ unitedhealthfoundation/ Advertise with diversity in The Portland Observer Call 503-288-0033 or email ads@portlandobserver.com
