MEDICARE 2025 CHANGES TO PART D PRESCRIPTION DRUG COVERAGE

in 2025, plans can have three simplified phases: 

• The Deductible Phase — The beneficiary is responsible for 100% of drug costs up to $590. 

• The Initial Coverage Phase — Costs are shared between the plan and the beneficiary, the beneficiary portion paid in the form of a copay or coinsurance. 

• The Catastrophic Coverage Phase — The plan is responsible for all costs.  

Both the limit for the end of the deductible period and the end of the initial coverage period use the beneficiary’s True Out Of Pocket (TrOOP) expenses (which include what the person themselves pays, plus payments made on their behalf by certain programs and charities). 

Payment Plans Are Available for Out-of-Pocket Costs 

Starting in 2025, beneficiaries can choose to spread their incurred out-of-pocket costs across the year. The program is optional and may be less useful to those who have relatively stable drug expenses.  This does not reduce costs but only distributes the costs across the remainder of the year.  This program is not the default but must be opted into. 

 People with unaffordable drug costs should also explore the Extra Help or Low-Income Subsidy program. 

See, Medicare in 2025: Key Changes and Updates - Medicare Rights Center