2025 Aetna Part D Premium - Massive Increase

[Retiredron]

Just received the Aetna 2025 annual notice of change and my premium for Part D (SilverScript Choice) is going from 9.90 to 44.90 per month. Can anyone help me understand the reasons for this massive increase? Thanks.

[prd1982]

Part of the increase is probably because of the new $2000 cap a person must spend in 2025. So the companies are raising the base rate to make up the difference. The drug companies continue to introduce new expensive drugs that raise costs. Insurance companies want increased profits. I know that Wellcare also had a large increase.

Note: even though it costs me, I’m in favor of capping the amount a person must spend.

[jebmke]

Wife's had similar move. I cautioned her to wait and look at all the plans at once using the Medicare tools since often plans get re-branded.

We usually do this at the end of the month or first half of November. Open enrollment runs through early December so no particular rush to deal with it now.

[rbd789]

Wife's had similar move. I cautioned her to wait and look at all the plans at once using the Medicare tools since often plans get re-branded.

We usually do this at the end of the month or first half of November. Open enrollment runs through early December so no particular rush to deal with it now.

Same here. My wellcare plan, on the other hand, is going from 0.50 to 0.00. She will probably be switching once we evaluate the latest pharmacy and drug lists. No hurry.

[jebmke]

Wife's had similar move. I cautioned her to wait and look at all the plans at once using the Medicare tools since often plans get re-branded.

We usually do this at the end of the month or first half of November. Open enrollment runs through early December so no particular rush to deal with it now.

Same here. My wellcare plan, on the other hand, is going from 0.50 to 0.00. She will probably be switching once we evaluate the latest pharmacy and drug lists. No hurry.

yes; mine dropped from $.40 to zero too. I plan to finally put a stake in the heart of CVS this cycle so I want to see what things look like with different sources. Also may need a new Rx which I won't know until early November so I may well wait until late November to spin the roulette wheel this time.

[bberris]

Just received the Aetna 2025 annual notice of change and my premium for Part D (SilverScript Choice) is going from 9.90 to 44.90 per month. Can anyone help me understand the reasons for this massive increase? Thanks.

The premium is only part of the cost, unless you don't have any prescriptions. Compare plans when all the rates and drug coverages are published on Medicare.gov. You can change part D during open enrollment with no restrictions.

[ModifiedDuration]

All the 2025 premium rates for Part D plans are now on the Medicare.gov site. You can enter your prescriptions and see the total cost for each Plan (premium and out-of-pocket cost).

WellCare Value Script is $0.00 in 42 states and is still $0 for Tier 1 and $5 for Tier 2 for 30 days, if you use a preferred pharmacy, such as CVS or Walgreens.

[Cicero123]

Percentage wise, I think I have you beat. My Wellcare is going from 40 cents to $17.40 a month…..

[bogles the mind]

My BCBS MA plan stayed $0. The monthly kick back went from $10 to $4. Coinsurance kicks in 1 tier lower on prescription drugs. OTC allowance went up to $120/quarter from $60.

[OnTrack2020]

Just received the Aetna 2025 annual notice of change and my premium for Part D (SilverScript Choice) is going from 9.90 to 44.90 per month. Can anyone help me understand the reasons for this massive increase? Thanks.

Yes, husband's increase was over 650%. And deductible also increased over 100%. You are going to want to check the formulary list if taking any prescription meds. One of the expensive meds husband is on wasn't pricing out when I went to website directly. But when I went to the government website for SilverScript, it's because it's not covered anymore (nor is the generic covered), so we won't be going with SilverScript for 2025.

Prescription meds are capped at $2,000 for 2025. Pharmaceutical companies have to make their money somehow.

[wwhan]

All the 2025 premium rates for Part D plans are now on the Medicare.gov site. You can enter your prescriptions and see the total cost for each Plan (premium and out-of-pocket cost).

WellCare Value Script is $0.00 in 42 states and is still $0 for Tier 1 and $5 for Tier 2 for 30 days, if you use a preferred pharmacy, such as CVS or Walgreens.

Thanks, the Medicare.gov site is indeed updated. In 2024 my Wellcare Value Script Plan ID: S4802-163-0 was $0.40/month, but for 2025 it is now $17.40/month

Now Cigna Healthcare Assurance plan is the cheapest 2025 part D plan here in California.
Cigna Healthcare Assurance Rx (PDP), Plan ID: S5617-158-0, Monthly Premium $1.80
Wellcare Classic (PDP), Plan ID: S4802-094-0, Monthly Premium $16.80
Wellcare Value Script (PDP), Plan ID: S4802-163-0, Monthly Premium $17.40
Cigna Healthcare Saver Rx (PDP), Plan ID: S5617-382-0, Monthly Premium $20.60

I don't have any prescriptions, so the only reason to have part D, is for vaccines & to avoid late enrollment penalties, once I do have prescriptions: https://www.medicare.gov/basics/costs/m ... -penalties

[capran]

[merge here - mod mkc]

Last week got a pamphlet from our existing Part D provider (Silver Script by Aetna). For 2025 it said monthly premium going up from 3.30 to 35.90 per month, with just a $.77 cost per three month tier one drug.

Today email from Medicare said their 2025 website was now available to compare plans. The first one listed is Wellcare Value Script (PDP) says monthly premium zero, and out of pocket tier one med zero. That seems like a no brainer, but in the Medicare handbook we received by mail has a column on the right that says "0-15% Copay and or 25-43% Coinsurance". I am assuming that might apply if we had a different med. Am I missing something? Seems almost too good to be true.

[jebmke]

I have this plan (this year). In my opinion it is not possible to know if it is a good deal, except in retrospect. If you find out in January that you need a drug that they no longer cover or is in a higher tier it can turn out that you chose wrong. This happened to me this year but it wasn't the end of the world and was not predictable. But also only a two-week regime.

[tallguy3891]

For 2025 in our area of CA, there are 16 Part D plans available, 10 of which are over $100 per month premiums. Some over $150/mo. Most of the plans also have a deductible; only 3 of the 16 plans do not have a deductible. Interesting that a standalone Part D plan can have a much larger premium than Medicare Advantage plans with the Part D embedded in them, many of which have zero premiums and have very nice Rx coverage.

[wwhan]

Here is another thread on this: viewtopic.php?t=440238

Now Cigna Healthcare Assurance plan is the cheapest 2025 part D plan here in California.

Cigna Healthcare Assurance Rx (PDP), Plan ID: S5617-158-0, Monthly Premium $1.80
Wellcare Classic (PDP), Plan ID: S4802-094-0, Monthly Premium $16.80
Wellcare Value Script (PDP), Plan ID: S4802-163-0, Monthly Premium $17.40 <<<< this seems to cover better for drugs than Classic
Cigna Healthcare Saver Rx (PDP), Plan ID: S5617-382-0, Monthly Premium $20.60

2025 plans here: https://www.medicare.gov/plan-compare/# ... 25&lang=en

[mkc]

[capran's topic has been merged into this existing one. Thank you to the member who reported it and provided a link to this topic. mod mkc]

[MtnBiker]

As others have mentioned, major changes were expected because of the new $2000 cap on (covered) drug costs. (No cap on uncovered drug costs.) Looking through the plans available for 2025 in my area, I notice some interesting trends.

• 1) Fewer plans are available. 12 in my area for 2025 vs. 20 for 2024.
  
  2) A number of plans now have what I would call very high monthly premiums. In my area, six of 12 have monthly premiums in the range of $72 to $122 per month. Of these six, two have zero deductible, one has a $175 deductible, and the remaining three have a $590 deductible.
  
  3) The other half of the plans in my area have low to moderate monthly premium ranging from $0 to $45 per month. All of these have deductibles of $573 to $590 (near the top of the allowed range).

As always, selection of a plan comes down to which has the lowest overall cost for the drugs you need. Those using only inexpensive generic drugs will of course select a low premium plan. For those of us who use one or more of the more expensive drugs, an important factor is whether a plan includes your drugs in their formulary.

It appears to me that the plans with low monthly premiums tend to have more restrictive formularies. Thus, these plans may not be an option for some. But if you are fortunate enough to find a low-premium plan which covers all your prescriptions, then the maximum out of pocket for the year in my area would be limited to the $2000 to $2500 range (depending on premium).

The plans with high monthly premiums appear to have richer formularies, so are a viable option for those who cannot find a suitable low-premium plan. In this case the maximum out of pocket cost in my area is in the $2800 to $3500 range.

For those using expensive drugs, the annual deductible isn't really a factor in the choice of plans, since we are going to pay something close to the $2000 annual cap on drug costs regardless of deductible.

Does anyone have a different view of the Part D plan selection situation this year?

[jebmke]

As always, selection of a plan comes down to which has the lowest overall cost for the drugs you need. Those using only inexpensive generic drugs will of course select a low premium plan. For those of us who use one or more of the more expensive drugs, an important factor is whether a plan includes your drugs in their formulary.

One other factor which is a bit more work is also getting cash price for a covered drug and comparing plans with and without the drug in question. In my wife's case, her overall cost is lower if she buys one outside insurance, even though it is covered and the plan she selects is different than if she includes it as one of her drugs.

[tallguy3891]

As others have mentioned, major changes were expected because of the new $2000 cap on (covered) drug costs. (No cap on uncovered drug costs.) Looking through the plans available for 2025 in my area, I notice some interesting trends.

• 1) Fewer plans are available. 12 in my area for 2025 vs. 20 for 2024.
  
  2) A number of plans now have what I would call very high monthly premiums. In my area, six of 12 have monthly premiums in the range of $72 to $122 per month. Of these six, two have zero deductible, one has a $175 deductible, and the remaining three have a $590 deductible.
  
  3) The other half of the plans in my area have low to moderate monthly premium ranging from $0 to $45 per month. All of these have deductibles of $573 to $590 (near the top of the allowed range).

As always, selection of a plan comes down to which has the lowest overall cost for the drugs you need. Those using only inexpensive generic drugs will of course select a low premium plan. For those of us who use one or more of the more expensive drugs, an important factor is whether a plan includes your drugs in their formulary.

It appears to me that the plans with low monthly premiums tend to have more restrictive formularies. Thus, these plans may not be an option for some. But if you are fortunate enough to find a low-premium plan which covers all your prescriptions, then the maximum out of pocket for the year in my area would be limited to the $2000 to $2500 range (depending on premium).

The plans with high monthly premiums appear to have richer formularies, so are a viable option for those who cannot find a suitable low-premium plan. In this case the maximum out of pocket cost in my area is in the $2800 to $3500 range.

For those using expensive drugs, the annual deductible isn't really a factor in the choice of plans, since we are going to pay something close to the $2000 annual cap on drug costs regardless of deductible.

Does anyone have a different view of the Part D plan selection situation this year?

In addition to my previous post above about 2025, our area is losing 6 plans from 2024, including 6 that were under $100/mo premiums, so in 2025 a higher % of plans are over $100. Also lost two zero deductible plans, down from 5 to 3.

Maybe more people will use the discount places for cash purchases for some Rx? The new Part D $2000 cap will be a huge benefit for some.

[JonFund]

Yes, I just read my Aetna Silverscripts plan for 2025 and saw the same thing. (Part D).
Not only has the monthly premium gone up nearly five-fold, but the deductible has doubled.

I'm having my agent shop around for a better deal. I see no upside whatsoever in staying with Aetna.

[jebmke]

Yes, I just read my Aetna Silverscripts plan for 2025 and saw the same thing. (Part D).
Not only has the monthly premium gone up nearly five-fold, but the deductible has doubled.

I'm having my agent shop around for a better deal. I see no upside whatsoever in staying with Aetna.

You can find the best deal easily on the Medicare web site (until your medical situation changes, of course and then the best deal may be a bad deal). I didn't even think agents bothered with Part D given the low dollar value.

[tallguy3891]

I noticed here in our area they also for 2025 are losing a net of one of the Medicare Advantage plans, and also there will now be zero UHC PPO MA plans (lost 3). Wonder if the reg changes also caused this in addition to the Part D plan losses/changes?

[cashmoney]

As others have mentioned, major changes were expected because of the new $2000 cap on (covered) drug costs. (No cap on uncovered drug costs.) Looking through the plans available for 2025 in my area, I notice some interesting trends.

• 1) Fewer plans are available. 12 in my area for 2025 vs. 20 for 2024.
  
  2) A number of plans now have what I would call very high monthly premiums. In my area, six of 12 have monthly premiums in the range of $72 to $122 per month. Of these six, two have zero deductible, one has a $175 deductible, and the remaining three have a $590 deductible.
  
  3) The other half of the plans in my area have low to moderate monthly premium ranging from $0 to $45 per month. All of these have deductibles of $573 to $590 (near the top of the allowed range).

As always, selection of a plan comes down to which has the lowest overall cost for the drugs you need. Those using only inexpensive generic drugs will of course select a low premium plan. For those of us who use one or more of the more expensive drugs, an important factor is whether a plan includes your drugs in their formulary.

It appears to me that the plans with low monthly premiums tend to have more restrictive formularies. Thus, these plans may not be an option for some. But if you are fortunate enough to find a low-premium plan which covers all your prescriptions, then the maximum out of pocket for the year in my area would be limited to the $2000 to $2500 range (depending on premium).

The plans with high monthly premiums appear to have richer formularies, so are a viable option for those who cannot find a suitable low-premium plan. In this case the maximum out of pocket cost in my area is in the $2800 to $3500 range.

For those using expensive drugs, the annual deductible isn't really a factor in the choice of plans, since we are going to pay something close to the $2000 annual cap on drug costs regardless of deductible.

Does anyone have a different view of the Part D plan selection situation this year?

The plan that is really standing out for those who take expensive brand names is the UHC Preferred plan with no deductible and fixed tier 3 copayments with about 100 premium depending on state.For example someone taking eliquis total drug cost for the year the 623.00 ,ozempic 435.00 and repatha 600.In these scenarios a person would reach their 2000 troop while spending much less than the 2000 troop on drug cost so even if they are on additional expensive drugs they are done paying drug cost for the year way before the 2000 troop

[tallguy3891]

This Part D cap seems to work oddly in my opinion. In the instance of those 3 expensive meds, Repatha, Ozempic, and Eliquis as an example, my area shows a premium for the cheapest plan at $1.80, and it does cover all those meds, and the way the cap is figured, if I am reading it correctly, apparently the $2000 cost (2025) would be all in january and zero for the rest of the year. (Or approx $167/mo x12 in 2025 with the smoothing option?) Seems good.

However, the plan which is $115.40 premium, covers all three and the cap is met in february so zero the rest of the year. So which is really better? Higher premiums all year with approx $1600+ oop, or way lower premium with $2000 oop?

I might be reading the site wrong and am not going to get into "show me, where..." back and forth, but it does look like it would be a good idea in my opinion to check out different plans with one's own meds. I think the Medicare site does a good job of showing the dollar amounts and timeframes.

[cashmoney]

This Part D cap seems to work oddly in my opinion. In the instance of those 3 expensive meds, Repatha, Ozempic, and Eliquis as an example, my area shows a premium for the cheapest plan at $1.80, and it does cover all those meds, and the way the cap is figured, if I am reading it correctly, apparently the $2000 cost (2025) would be all in january and zero for the rest of the year. (Or approx $167/mo x12 in 2025 with the smoothing option?) Seems good.

However, the plan which is $115.40 premium, covers all three and the cap is met in february so zero the rest of the year. So which is really better? Higher premiums all year with approx $1600+ oop, or way lower premium with $2000 oop?

I might be reading the site wrong and am not going to get into "show me, where..." back and forth, but it does look like it would be a good idea in my opinion to check out different plans with one's own meds. I think the Medicare site does a good job of showing the dollar amounts and timeframes.

If the all in cost are the same then arguably the plan with high premium is usually better because those plans tend to have the most robust formularies which is better to have in case you get prescribed a new brand name drug .

The reason the no deductible plan with fixed copayment tier 3 plan is so strong as opposed to low premium plan with a 25% coinsurance for some people with expensive brand names is because of how the TROOP is calculated

Assume a plan has no deductible and a 47.00 tier 3 .For example Ozempic cost about 1000.00 so first month you get 590.00 credit for deductible (even if your plan has no deductible) towards the TROOP.You also get 25% of difference between the 1000.00 cost of the drug and the the deductible of 590.00 which is 410 x .25= 102.5 So in first month you have already met 692.50 towards the 2000 TROOP.next month you pay 47.00 for tier 3 ozempic but you are getting 25% of the cost of ozempic which is 250.00 and so forth so you reach the 2000 TROOP after paying 47.00 for 7 month for total of 329.00 OOP drug cost

[MtnBiker]

The plan that is really standing out for those who take expensive brand names is the UHC Preferred plan with no deductible and fixed tier 3 copayments with about 100 premium depending on state.For example someone taking eliquis total drug cost for the year the 623.00 ,ozempic 435.00 and repatha 600.In these scenarios a person would reach their 2000 troop while spending much less than the 2000 troop on drug cost so even if they are on additional expensive drugs they are done paying drug cost for the year way before the 2000 troop

Thanks for your response. I now see that I had a misconception about how the $2000 spending cap works. I thought it meant that you would be charged no more than $2000 for the cost of covered drugs but would still need to pay the plan premium in addition. But that is clearly not the case.

I am looking at the estimated charges presented on the Medicare website for the UHC Preferred plan with no deductible and fixed Tier 3 copayments. In my location, the premium is $86.80/month ($1041.60/year) and the Tier 3 copayment is $47/month. The website estimates that the total cost (for covered drugs plus premiums) caps out at $2169.60, or $1128 for total drug costs (neither value being $2000).

I would like to try to understand the formula that defines when the spending cap is reached. Is there some reference you can provide which explains how the out-of-pocket limit will be calculated in 2025?

[ModifiedDuration]

The $2,000 maximum is your actual cash out-of-pocket cost - what you pay out-of-pocket for deductible, copays, and coinsurance.

Premium would be on top of that.

It doesn’t seem that is what some people are saying.

[azb]

This Part D cap seems to work oddly in my opinion. In the instance of those 3 expensive meds, Repatha, Ozempic, and Eliquis as an example, my area shows a premium for the cheapest plan at $1.80, and it does cover all those meds, and the way the cap is figured, if I am reading it correctly, apparently the $2000 cost (2025) would be all in january and zero for the rest of the year. (Or approx $167/mo x12 in 2025 with the smoothing option?) Seems good.

However, the plan which is $115.40 premium, covers all three and the cap is met in february so zero the rest of the year. So which is really better? Higher premiums all year with approx $1600+ oop, or way lower premium with $2000 oop?

I might be reading the site wrong and am not going to get into "show me, where..." back and forth, but it does look like it would be a good idea in my opinion to check out different plans with one's own meds. I think the Medicare site does a good job of showing the dollar amounts and timeframes.

If the all in cost are the same then arguably the plan with high premium is usually better because those plans tend to have the most robust formularies which is better to have in case you get prescribed a new brand name drug .

The reason the no deductible plan with fixed copayment tier 3 plan is so strong as opposed to low premium plan with a 25% coinsurance for some people with expensive brand names is because of how the TROOP is calculated

Assume a plan has no deductible and a 47.00 tier 3 .For example Ozempic cost about 1000.00 so first month you get 590.00 credit for deductible (even if your plan has no deductible) towards the TROOP.You also get 25% of difference between the 1000.00 cost of the drug and the the deductible of 590.00 which is 410 x .25= 102.5 So in first month you have already met 692.50 towards the 2000 TROOP.next month you pay 47.00 for tier 3 ozempic but you are getting 25% of the cost of ozempic which is 250.00 and so forth so you reach the 2000 TROOP after paying 47.00 for 7 month for total of 329.00 OOP drug cost

Cashmoney, this is extremely helpful. can you point me to good resource that explains how TROOP is calculated?

[cashmoney]

The $2,000 maximum is your actual cash out-of-pocket cost - what you pay out-of-pocket for deductible, copays, and coinsurance.

Premium would be on top of that.

It doesn’t seem that is what some people are saying.

Your OOP and TROOP are two different things because some of the insurance companies contributions goes toward 2000 TROOP ( true out of pocket).Premiums do not factor in for OOP or TROOP.If you have a 25% co insurance for tier 3 on your drug plan on a 1000.00 drug the insurance company is not contributing toward your 2000 troop vs on a fixed copay plan of 47.00 the insurance company is contributing 250.00 towards your 2000 troop. It is easy to see this in action on medicare,gov just put in ozempic and it will give your OOP and if then add additional covered drugs that are at fixed copayment you will see the OOP shouldn't change

[MtnBiker]

The $2,000 maximum is your actual cash out-of-pocket cost - what you pay out-of-pocket for deductible, copays, and coinsurance.

Premium would be on top of that.

It doesn’t seem that is what some people are saying.

I also thought the $2000 maximum was the actual cash out of pocket for buying drugs. But that isn't what the plan comparison tool on the Medicare.gov site is saying when it reports what you have to pay under different plans.

For example, this is what is reported for some plans for the annual cost of the same three drugs. (Without insurance coverage, the cash price for these drugs is well over $10,000.)

Case 1) UHC Preferred Plan
3 drugs covered at Tier 3 for $47/mo each.
No deductible
Drug cost caps out in 7 months at $987
Annual Premium $1041.60
Total Cost (drugs plus premium) $2028.60

Case 2) Humana Value
2 drugs covered in Tier 3 at 20% and 1 drug covered in Tier 4 at 35%.
Deductible $573
Drug cost caps out in 7 months at $1785.48
Annual Premium $357.60
Total Cost (drugs plus premium) $2143.08

Case 3) Humana Premier
2 drugs covered in Tier 3 at 45% and 1 drug covered in Tier 4 at 50%.
No deductible
Drug cost caps out in 6 months at $1152.05
Annual Premium $1462.80
Total Cost (drugs plus premium) $2614.85

Of the five plans in my area that cover all three of these drugs, I found only one that caps out at $2000 actual cash out of pocket:

Case 4) Humana Basic
2 drugs covered in Tier 3 at 22% and 1 drug covered in Tier 4 at 45%.
Deductible $590
Drug cost caps out in 7 months at $2000.00
Annual Premium $181.20
Total Cost (drugs plus premium) $2181.20

There seems to be no cost sharing by the insurance company at the 22% coinsurance level (and with full $590 deductible).

[ModifiedDuration]

Since in 2025 there will be a $2,000 maximum on out-of-pocket costs, it appears there is a flaw in the Medicare.gov site that should be fixed shortly.

Things like this have happened in the past when they first put information on Medicare.gov on October 1 and then they straighten it out by the time open enrollment starts on October 15.

[jebmke]

This is why I normally wait until early November. I think open enrollment runs into December so there really isn't a compelling reason to hurry.

[azb]

Since in 2025 there will be a $2,000 maximum on out-of-pocket costs, it appears there is a flaw in the Medicare.gov site that should be fixed shortly.

Things like this have happened in the past when they first put information on Medicare.gov on October 1 and then they straighten it out by the time open enrollment starts on October 15.

I originally thought these were errors as well, but am now persuaded that this is not the case. As Cashmoney explains in a post above, True Out of Pocket (TROOP) expenses is not the same as out-of-pocket. A plan's deviations from the Medicare standard deducible and 25% copay requirement is added to the TROOOP calculation. If a plan does not have a deductible and charges a flat co-pay (as opposed to a percentage), expensive drugs will quickly get to the $2000 TROOP cap even though the cash you actually paid is much lower.

I did not understand the differences in TROOP and OOP, and am grateful to cashmoney's explanation--it wil save me lots of money this year.

[celia]

Just received the Aetna 2025 annual notice of change and my premium for Part D (SilverScript Choice) is going from 9.90 to 44.90 per month. Can anyone help me understand the reasons for this massive increase? Thanks.

For 2024, the premiums dropped a lot. Did you question why the premiums were so low in 2024? (We were paying only $0.40 after a year of paying $69/ month.) How much were you paying in 2023?

The reason is that Part D is in the middle of an overhaul. Medicare will be able to negotiate rates on 10 more expense meds each year. There will be a new max out of pocket. The "donut hole" is disappearing. All are happening at the same time.

[celia]

The $2,000 maximum is your actual cash out-of-pocket cost - what you pay out-of-pocket for deductible, copays, and coinsurance.

Premium would be on top of that.

It doesn’t seem that is what some people are saying.

I also thought the $2000 maximum was the actual cash out of pocket for buying drugs. But that isn't what the plan comparison tool on the Medicare.gov site is saying when it reports what you have to pay under different plans.

Open enrollment doesn't open until Oct. 15. Meanwhile the website is likely being changed each day. Don't waste your time looking before then.

[celia]

Part of the increase is probably because of the new $2000 cap a person must spend in 2025. So the companies are raising the base rate to make up the difference. The drug companies continue to introduce new expensive drugs that raise costs. Insurance companies want increased profits. I know that Wellcare also had a large increase.

Note: even though it costs me, I’m in favor of capping the amount a person must spend.

What??? There's no MUST SPEND. On the contrary, $2,000 is the most you will spend if/ when you pick up your meds.

[ModifiedDuration]

Since in 2025 there will be a $2,000 maximum on out-of-pocket costs, it appears there is a flaw in the Medicare.gov site that should be fixed shortly.

Things like this have happened in the past when they first put information on Medicare.gov on October 1 and then they straighten it out by the time open enrollment starts on October 15.

I originally thought these were errors as well, but am now persuaded that this is not the case. As Cashmoney explains in a post above, True Out of Pocket (TROOP) expenses is not the same as out-of-pocket. A plan's deviations from the Medicare standard deducible and 25% copay requirement is added to the TROOOP calculation. If a plan does not have a deductible and charges a flat co-pay (as opposed to a percentage), expensive drugs will quickly get to the $2000 TROOP cap even though the cash you actually paid is much lower.

I did not understand the differences in TROOP and OOP, and am grateful to cashmoney's explanation--it wil save me lots of money this year.

You don’t have to think about TROOP in 2025.

It’s just a $2,000 cash out-of-pocket limit in 2025, not TROOP.

[boater07]

I'm starting to wonder whether the Wellcare value script is actully for 2025.
$0 premium can't be right. My generics total $42 for the year.
I am also having trouble with the medicare.gov site. it gets me to agents instead
of comparison..

[cashmoney]

Since in 2025 there will be a $2,000 maximum on out-of-pocket costs, it appears there is a flaw in the Medicare.gov site that should be fixed shortly.

Things like this have happened in the past when they first put information on Medicare.gov on October 1 and then they straighten it out by the time open enrollment starts on October 15.

This is exactly how it is supposed to work i saw demos on this from the largest insurance part D carriers prior to Oct 1.They used Ozempic as the example to show the benefit of the no deductible fixed tier 3 plan vs the plan with deductible and 25% coinsurance for tier 3.The reason they use 25% is because the standard model of part D is a plan with a 590.00 deductible and 25% co insurance so the most cost share the insurance contributes towards troop is 25%.I can't share that slide that was used in the training but they are out there on the internet.

The irony about this is next year when they start negotiating lower prices for drugs like Eliquis it may actually increase the OOP for some people on plans with a fixed tier 3 since the insurance companies 25% cost share contribution toward the troop will be less

[VincentP]

Your best move is to go to Medicare.gov, create an account and input all your medications. The 2025 Part D plans are now available on the site to compare plan costs. They will list the plans by least expensive to most expensive (based on premium plus total drug costs). The other thing is new this year is a maximum out of pocket cost of $2000 NOT including the monthly premium.

[ModifiedDuration]

I'm starting to wonder whether the Wellcare value script is actully for 2025.
$0 premium can't be right. My generics total $42 for the year.
I am also having trouble with the medicare.gov site. it gets me to agents instead
of comparison..

WellCare Value Script will have a $0.00 premium in 42 states in 2025.

[cashmoney]

Since in 2025 there will be a $2,000 maximum on out-of-pocket costs, it appears there is a flaw in the Medicare.gov site that should be fixed shortly.

Things like this have happened in the past when they first put information on Medicare.gov on October 1 and then they straighten it out by the time open enrollment starts on October 15.

I originally thought these were errors as well, but am now persuaded that this is not the case. As Cashmoney explains in a post above, True Out of Pocket (TROOP) expenses is not the same as out-of-pocket. A plan's deviations from the Medicare standard deducible and 25% copay requirement is added to the TROOOP calculation. If a plan does not have a deductible and charges a flat co-pay (as opposed to a percentage), expensive drugs will quickly get to the $2000 TROOP cap even though the cash you actually paid is much lower.

I did not understand the differences in TROOP and OOP, and am grateful to cashmoney's explanation--it wil save me lots of money this year.

You don’t have to think about TROOP in 2025.

It’s just a $2,000 cash out-of-pocket limit in 2025, not TROOP.

Troop is still important in 2025 because like the 8000.00 troop in 2024 it is the point at which your cost share go to 0 even though you didn't spend anywhere near( 8000 in 2024 ) it to get there ( usually around 3200.00 in 2024) it's just that in 2025 the insurance company is possibly contributing toward your troop from the beginning of the year when in the initial stage instead of kicking in only after the gap is reached.With that said i do notice that the terminology is not being used in consumer facing literature but the troop is still in play as a calculation of the total of what the consumer and insurance companies contribute that get you to the point where you have no more cost share even though you have not spent 2000 in drug cost.

[tallguy3891]

Since in 2025 there will be a $2,000 maximum on out-of-pocket costs, it appears there is a flaw in the Medicare.gov site that should be fixed shortly.

Things like this have happened in the past when they first put information on Medicare.gov on October 1 and then they straighten it out by the time open enrollment starts on October 15.

I originally thought these were errors as well, but am now persuaded that this is not the case. As Cashmoney explains in a post above, True Out of Pocket (TROOP) expenses is not the same as out-of-pocket. A plan's deviations from the Medicare standard deducible and 25% copay requirement is added to the TROOOP calculation. If a plan does not have a deductible and charges a flat co-pay (as opposed to a percentage), expensive drugs will quickly get to the $2000 TROOP cap even though the cash you actually paid is much lower.

I did not understand the differences in TROOP and OOP, and am grateful to cashmoney's explanation--it wil save me lots of money this year.

You don’t have to think about TROOP in 2025.

It’s just a $2,000 cash out-of-pocket limit in 2025, not TROOP.

Troop is still important in 2025 because like the 8000.00 troop in 2024 it is the point at which your cost share go to 0 even though you didn't spend anywhere near( 8000 in 2024 ) it to get there ( usually around 3200.00 in 2024) it's just that in 2025 the insurance company is possibly contributing toward your troop from the beginning of the year when in the initial stage instead of kicking in only after the gap is reached.With that said i do notice that the terminology is not being used in consumer facing literature but the troop is still in play as a calculation of the total of what the consumer and insurance companies contribute that get you to the point where you have no more cost share even though you have not spent 2000 in drug cost.

Thanks for helping clarify this issue. As an example, we are on FEHB and have as part of our plan a Part D Rx option which was rolled out last year with the $2000 cap (a year early). My spouse had to use some very expensive specialty meds this year. Even though it stated we have the $2000 cap, that was not all out of our pocket, but rather the calculation includes cost paid by other sources as mentioned. I estimate we paid out of pocket about $1200 for the year from jan-apr. Since then, we have paid zero out of pocket for any meds the rest of the year since the $2000 cap was met--just not all from our pocket.