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
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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
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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
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ed Health Foundation provides
scholarships to support the pro-
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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
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https://scholarshipamerica.org/
unitedhealthfoundation/
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