Medicare Open Enrollment is just around the corner, making it the perfect time to review and consider any adjustments to your current Medicare coverage. With the recent updates from the Inflation Reduction Act, Medicare has seen some major improvements, with even more changes on the way. Now is the time to explore how these updates could impact your plan and coverage.
How Medicare Open Enrollment Works
Medicare Open Enrollment takes place annually and will run from October 15 to December 7, 2024. Any changes you make during this period will go into effect on January 1, 2025.
During Medicare Open Enrollment, you have the option to:
– Enroll in or drop a Medicare Advantage Plan, switch between plans, or update your prescription drug coverage
– Switch from Original Medicare to a Medicare Advantage Plan, or vice versa
– Add, drop, or change your Medicare prescription drug plan if you’re enrolled in Original Medicare
If you’re already enrolled in a Medicare Advantage Plan, you’ll also have another open enrollment window from January 1 to March 31, 2025, during which you can:
– Switch to a different Medicare Advantage Plan (with or without prescription coverage)
– Drop your Medicare Advantage Plan and return to Original Medicare
– Enroll in a standalone Medicare prescription drug plan
Learn more about the different Medicare enrollment periods and how to navigate your plan options.
Medicare Members Enjoy Reduced Drug Costs
A major change on the horizon for Medicare beneficiaries is the reduction in prescription drug prices. Thanks to the Inflation Reduction Act (IRA), the federal government now has the power to negotiate prices for select high-cost medications covered by Medicare. This groundbreaking initiative aims to lower out-of-pocket costs for beneficiaries while reducing overall expenses for the Medicare program.
Starting in 2026, the first set of negotiated prices will go into effect, impacting the cost of 10 widely-used prescription drugs. These medications were selected based on their high price, availability from single sources, and lack of generic or biosimilar alternatives.
The chart below highlights the initial 10 drugs that will see price reductions through this program. The prices are rounded estimates of the Wholesale Acquisition Costs (WACs) for a 30-day supply in 2022.
Manufacturers of these drugs are voluntarily participating in the Negotiation Program, and the details are subject to change. For more information, visit the Centers for Medicare & Medicaid Services (CMS) website.
Negotiated Prices for 10 Medicare Drugs (effective in 2026)
Drug Name | Commonly Treated Condition | List Price for 30-Day Supply in 2023 | Discount of Negotiated Price From 2023 List Price | Agreed-to Negotiated Price for 30-Day Supply for 2026 |
Januvia | Diabetes | $527 | 79% | $113 |
Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog PenFill | Diabetes | $495 | 76% | $119 |
Farxiga | Diabetes, Heart failure, Chronic kidney disease | $556 | 68% | $178.50 |
Enbrel | Rheumatoid arthritis, Psoriasis, Psoriatic arthritis | $7,106 | 67% | $2,355 |
Jardiance | Diabetes, Heart Failure, Chronic kidney disease | $573 | 66% | $197 |
Stelara | Psoriasis, Psoriatic arthritis, Crohn’s disease, Ulcerative colitis | $13,836 | 66% | $4,695 |
Xarelto | Prevention and treatment of blood clots, Reduction of risk for patients with coronary or peripheral artery disease | $517 | 62% | $197 |
Eliquis | Prevention and treatment of blood clots | $521 | 56% | $231 |
Entresto | Heart failure | $628 | 53% | $295 |
Imbruvia | Blood cancers | $14,934 | 38% | $9,319 |
If you are prescribed any of the 10 drugs affected by these upcoming price changes, it’s important to stay updated on developments. Although the lower prices won’t take effect until 2026, planning ahead can help you prepare for potential savings and make informed choices during the 2025 Open Enrollment period.
Beyond the initial 10 drugs, the Centers for Medicare & Medicaid Services (CMS) will select 15 additional drugs covered under Medicare Part D for price negotiations by February 1, 2025, with lower prices going into effect in 2027. For 2028, CMS will negotiate prices for 15 more drugs covered under both Medicare Part B and Part D. Starting in 2029 and beyond, up to 20 more Part B and Part D drugs will be added to the list each year for lower negotiated prices.
Americans Continue to Pay More for Medication
Despite these upcoming price reductions, Americans still pay significantly more for brand-name prescription medications than most other countries. According to The Commonwealth Fund, U.S. per capita spending on pharmaceuticals is nearly three times higher than the average across other Organisation for Economic Co-operation and Development (OECD) nations.
A 2022 study published in JAMA revealed that around 20% of U.S. adults aged 65 and older have taken steps to cut their prescription drug costs. This includes delaying or skipping prescription refills, reducing doses, or using someone else’s medication. Some respondents reported having to sacrifice basic needs or incur debt to afford their prescriptions. These cost-saving measures can have serious health risks, particularly for individuals managing chronic conditions.
Additional Changes and New Medicare Benefits
Medicare beneficiaries will benefit from a yearly cap on out-of-pocket prescription drug costs, with the limit set at $2,000 for 2025. Additionally, insulin costs are capped at $35 per month per covered prescription for those enrolled in Medicare Part D, although this cap may not apply to all insulin products. Be sure to check with your healthcare provider to see if this applies to your specific medication.
Recommended vaccines will also be available at no cost for individuals with Medicare prescription drug coverage. Furthermore, the Medicare Part D low-income subsidy program, known as Extra Help, has been expanded to include those with an annual income up to 150% of the federal poverty level (FPL). If your income meets this threshold, you may qualify for Extra Help.
Lastly, pharmaceutical companies that increase drug prices faster than the rate of inflation will be required to pay a rebate to Medicare, helping to control rising costs.
Medicare Considerations for Estate Planning
Like most health insurance plans, Medicare and its associated programs have specific details and complexities. It’s important to consult with a healthcare professional before choosing a Medicare plan that works for you. Likewise, consulting with an elder law attorney offers you peace of mind for protecting your assets and estate. Although Bromlow Law does not provide guidance on Medicare or Medicaid, we are happy to assist you with other estate planning and elder law concerns.
For additional reading on Medicare and late-life planning, explore the following articles:
- Medicare Part D Plans 2024: Prescription Drug Coverage
- Pay Monthly for Medicare Part D Prescriptions Come 2025
- Medicare Advantage: An Alternative to Original Medicare
- Why Hire an Elder Law Attorney?
Bromlow Law, PLLC and Laura L. Bromlow, are dedicated to the practice of Elder Law and Estate Planning. Our practice focuses solely on working with clients in these and closely related legal fields. Laura L. Bromlow is a Certified Elder Law Attorney with the National Elder Law Foundation. Bromlow Law, PLLC strives to enhance communication among family members and loved ones and to keep them all out of conflict so they can stay out of court. We want to help you keep your close circle safe!
Please contact our office today at (281) 665-3807 to schedule a free consultation to discuss your legal matters. We look forward to the opportunity to work with you.