Devoted 100% to 2025 drug plans in Georgia

Information below regarding the 2025 plans comes from the Medicare & You handbook for 2025 and other linked resources. You should have received your handbook from CMS if you have opted in to their mailings.

There are only 14 plans offered in 2025 . . . in 2024 we had 20 offerings. In 2023 we had 26 stand alone drug plans.

Premiums range from $0 to $160 per month

Only TWO plans do not have a deductible

Nine plans will apply the $590 deductible to some or all tiers.

In other words, premiums and what you pay for medications will generally be HIGHER, not lower as spun by the mainstream media.

Also . . . plan names may be the same as this year but that does not mean your coverage is the same. Some carriers are using new plan names which will further confuse the issues.

Aetna has only 1 plan (SilverScript Choice) for 2025 . . . the new premium will be $51. If you currently have the SilverScript Saver plan ($16) or the SilverScript Plus plan ($100) and do nothing, you will be migrated to the “new” Choice plan. Your new premium will be $51, the $590 deductible applies to ALL tiers. The SilverScript Plus plan, $100 premium and NO deductible will not be offered in 2025.

Anthem will offer 2 plans next year. The 2025 Mediblue Standard plan has a premium of $144; the Plus plan premium will be $160. The PLUS plan has a deductible of $155 which applies to “some” drugs . . . a $590 deductible applies to all drugs on the STANDARD plan formulary.

Cigna offers 3 plans for 2025 with premiums of $21 for the Saver plan, $99 for the Assurance plan and $112 for the Extra plan. The SAVER deductible is $590 and applies to “some” drugs; the Assurance deductible is $590 and applies to all drugs, the Extra plan has a $175 deductible that applies to “some” drugs.

Humana is offering 3 plans for 2025. The Basic plan premium will be $16; the Value premium will be $42 and the Premier premium will be $136 and have NO deductible.

UHC/AARP offers 2 plans for next year. The Saver premium will be $82; the Preferred plan premium will be $100 and has NO deductible.

Wellcare will have 3 plans for 2025. Premiums are $0 for the Value Script plan; $15 for the Classic and $112 for the Value Plus plan. A deductible of $590 will apply to SOME drugs on Value Script and Value Plus plan; the $590 deductible will apply to all drugs on the Classic plan.

Mutual of Omaha is withdrawing from the Part D market. If you currently have an Omaha plan you will need to find a new plan for 2025.

Please do not call or email to ask which plan you have. The name of your plan is on your Part D card or call your pharmacy and ask. As much as I want to help, this season looks to be busier than normal and I won’t have time to look for the name of the plan you have.

DON’T BELIEVE THE HYPE

Drug price negotiation - “Negotiated” drug prices won’t go into effect until 2026. 

Only 10 drugs will be negotiated.

Apixaban, Januvia, Enbrel, Empaglifozin, Dapagliflozin, Ibrutinib, Xarelto, Sacubitril/Valsartan, Ustekinumab, Insulin Aspart.

$2,000 out of pocket cap - It is estimated that 1,000,000 seniors will benefit from the 2025 $2,000 out of pocket cap. The remaining 66 million people on Medicare will not be impacted by the cap . . . but their premiums and out of pocket costs WILL go up anyway.

Moreover, the cap only applies to drugs that are on your plan formulary. Part B drugs and some chemotherapy drugs are not subject to the $2,000 spending cap.

For those who have OM (original Medicare) and a Medigap G plan your out of pocket for Part B covered drugs should be limited to the Part B deductible.In 2024 the Part B deductible is $240.

Premiums are up significantly for many of us. Some will see their premium double or triple for 2025 unless you change plans. I will help as many as I can, but if you want to self enroll via MyMedicare you can.

Many plans are not paying an agent commission in 2025. This does not affect me since I have NEVER accepted a commission for Part D. However, many agents are refusing to show or offer drug plans that will not pay a commission. With me, you can see all 10 plans if you want. However, I usually send details for only the lowest total cost. In some cases I will show a SUMMARY comparison of the 2 or 3 low cost plans.

Insulin - The $35 copay for insulin has some twists and turns. Your $35 copay does not apply to ALL insulin. Participating plans do not have to cover all insulin products at the $35 monthly copayment amount, just one of each dosage form (vial, pen) and insulin type (rapid-acting, short-acting, intermediate-acting, and long-acting). If your insulin copay in 2024 is $35 do not assume it will be the same in 2025.To get the $35 pricing your brand/type of insulin must be on the formulary AND you must use a preferred pharmacy.

Preferred pharmacy - The 2025 drug plans have smaller networks and fewer preferred pharmacies. The lowest copays will generally be available if you use a PREFERRED pharmacy. Check your plan to determine which pharmacy is preferred.

Discount cards - Only used for GENERIC drugs. Compare pricing vs your drug plan copay. Use discount cards (including in store savings plans) to maximize your cost savings. 

High priced brand name drugs - Some of you MAY benefit from grants or special assistance that can help cover your out of pocket cost for prescription drugs. I can run reports for most of these medications. Just ask. I will need the exact name of your drug and dosage.

You may also want to consider mailorder from suggested Canadian pharmacies. Some generic equivalents are available from Canada . . . and the generic is NOT available in the states.

Other Changes . . .

Flat dollar copays may only apply to tier 1 & 2 drugs, depending on the plan you select. Tier 3 and higher drugs will have coinsurance where you will be required to pay 15% to 50% of the retail cost.

Network pharmacy. Some medications may not be covered by your plan if you do not use a network pharmacy. Check your plan pharmacy directory, or ask your pharmacist if they are in network for your plan, BEFORE filling your prescription.

Medicare Prescription Payment Plan, also referred to as “smoothing”, may be mandated if you have higher cost medications. Covered formulary drugs that are subject to the $2,000 annual cap will be “smoothed” allowing you to pay a smaller monthly amount vs a much larger amount up front. This should make it easier to budget for higher cost medications.

In 2025 your pharmacy will be allowed to substitute biosimilar medications for generics. Biosimilar medications are similar to generics but not identical.

More information on smoothing, biosimilars and other changes here . . .

https://www.investopedia.com/major-medicare-changes-for-2025-8713206#toc-7-youll-have-better-access-to-lower-cost-biosimilar-prescription-drugs

In Closing . . .

Not much to laugh about in this issue. Every one of these changes is a result of Congress attempting to “fix” Part D and lower the cost of prescription drugs.

Open Enrollment officially starts October 15th and ends December 7th. This is the only time you can enroll in a NEW plan to be effective 1/1/2025. Your current plan will remain into effect until 12/31/2024.

If you do not make a change, your current plan will migrate to the 2025 version.

Feel free to pass this along to your friends . . .

Bob & Rachel