300% Increase in Part D Plan for 2025

[Donno]

I just got my 2025 Annual Notice of Change for my SilverScript Part D plan, and the rumors I heard about massive increases in plan D prices appear to be correct. My monthly premium amount is going from $12.30 to $47.30 and the deductible is increasing from $280 to $590. In addition, there are increases in co-payments for tier 1 and 2 drugs.

My understanding is these increases are a direct result of the Inflation Reduction Act which capped insulin prices and created an annual max out of pocket of $2000 for 2025 which is good, but apparently transferred a lot of those costs on to insurance companies which means everyone pays for it.

I'm curious to see what everyone else will see for premiums next year, and to see if my current plan will remain one of the least expensive in my area.

 

[street]

Great!!!! Thanks for sharing that info.

 

[VanWinkle]

S.O. is paying .50 cents per month now and we could survive a 300% increase on that amount. I thought the plan would not pay well, but have been pleasantly surprised as it paid better than her ACA health plan on prescriptions.

 

[FiveDriver]

I'm not sure you can draw a straight line from SilverScript cost increases to the Inflation Reduction Act.

In my opinion, you should start shopping for other Part D plans. Have you looked into WellCare recently ?? What kind of Rx are you buying ?

 

[MichaelB]

I agree more premiums / plan comparisons are needed. Nonetheless, reducing the cap on total out of pocket to $2000 has to unavoidably impact Plan D premiums. Insurers cannot accept a higher share of the cost without passing it along to policyholders.

Like all insurance, the beneficiaries are the consumers with the greatest prescription drug spending, while all policyholders pay. We all still have the option to compare plan coverage and premiums and then change plans annually.

 

[RetiredHappy]

I would assume the cap of $2K max OOP for drugs results in Medicare paying majority of the balance as opposed to passing them all on to insurers.

 

[harllee]

My Silverscript is going up from $5.20 to $40.20 per month and deductible is going up from $280 to $590. Since I am lucky and don't take any prescriptions I will be shopping for a cheaper plan come October 15.

 

[target2019]

$12.40 per month to $47.40 per month.

combining SilverScript SmartSaver (PDP) with one of our plans, SilverScript Choice (PDP).

There are other cost increases, like the deductible, and the co-pay.

If not using the plan, then it makes sense to search for something more appropriate given your use. That is the situation for my wife. Me, I hit catastrophic coverage, so it's gonna be interesting to see what other plans offer.

 

[Donno]

Here is a CMS link if anyone is interested that sheds some light on the upcoming year cost sharing. In short, the plan picks up 60% of the cost of all medications over the $2000 MOOP and CMS and/or the manufacturer pick up the rest. That is up substantially from prior years.

Final CY 2025 Part D Redesign Program Instructions Fact Sheet | CMS

Today, the Centers for Medicare & Medicaid Services (CMS) released the Final Calendar Year (CY) 2025 Part D Redesign Program Instructions (the Final Program Instructions) concurrently with the CY 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate...

www.cms.gov

I am certainly going to shop around and compare premiums, but I think they are all going to be much higher.

 

[MichaelB]

Here is a CMS link if anyone is interested that sheds some light on the upcoming year cost sharing. In short, the plan picks up 60% of the cost of all medications over the $2000 MOOP and CMS and/or the manufacturer pick up the rest. That is up substantially from prior years.

Final CY 2025 Part D Redesign Program Instructions Fact Sheet | CMS

Today, the Centers for Medicare & Medicaid Services (CMS) released the Final Calendar Year (CY) 2025 Part D Redesign Program Instructions (the Final Program Instructions) concurrently with the CY 2025 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies (the Rate...

www.cms.gov

I am certainly going to shop around and compare premiums, but I think they are all going to be much higher.

Great link, thanks.

 

[target2019]

So we're gonna have the OOP, the MOOP, and the TrOOP.

Anything else?

 

[MichaelB]

So we're gonna have the OOP, the MOOP, and the TrOOP.

Anything else?

Program out of pocket?

 

[target2019]

Program out of pocket?

As I tell myself frequently, "We're born, we die, and in between, we POOP!"

 

[FiveDriver]

Program out of pocket?

After all that, you'll probably need the Senior Citizen Out of Pocket.
SCOOP !!

 

[aja8888]

Of course, don't forget the CPP!

(Canadian Pharmacy Purchase)

 

[RetMD21]

I agree more premiums / plan comparisons are needed. Nonetheless, reducing the cap on total out of pocket to $2000 has to unavoidably impact Plan D premiums. Insurers cannot accept a higher share of the cost without passing it along to policyholders......

I guess somebody has to pay, right?

 

[marko]

I agree more premiums / plan comparisons are needed. Nonetheless, reducing the cap on total out of pocket to $2000 has to unavoidably impact Plan D premiums. Insurers cannot accept a higher share of the cost without passing it along to policyholders.

Always amazes me how these types of decisions are made without consideration of the possible consequences. The thought process seems to always assume that these things are static and won't change in response. Like just about everything else "somebody's got to pay for it".

 

[ERD50]

Always amazes me how these types of decisions are made without consideration of the possible consequences. The thought process seems to always assume that these things are static and won't change in response. Like just about everything else "somebody's got to pay for it".

In this case, I'm not so certain these were unknown consequences. If all else is equal, then surely reducing a max OOP means something else has to give.

Devil's in the details, but this could be a reasonable give-take overall. Of course, politicians will boast of the benefits to voters, and never mention that it shifts the burden somewhere else.

 

[RetMD21]

Always amazes me how these types of decisions are made without consideration of the possible consequences. The thought process seems to always assume that these things are static and won't change in response. Like just about everything else "somebody's got to pay for it".

Isn't it basically a trade-off of better insurance or cheaper insurance?

 

[MichaelB]

This is not just rearranging costs among consumers. Like Part B, Medicare partially subsidizes Plan D. We all can then choose among Plan D options that reflect different combinations of prescription drug use. So, consumers that have many prescriptions will pay more while people that use few or no prescription drugs will pay less.

Here’s a good overview by KFF An Overview of the Medicare Part D Prescription Drug Benefit | KFF

 

[harllee]

I will wait and see how it all shakes out on the SS website after Oct 10. I bet there will be some cheaper options for those of us who take few prescriptions.

 

[MBSC]

Nonetheless, reducing the cap on total out of pocket to $2000 has to unavoidably impact Plan D premiums. Insurers cannot accept a higher share of the cost without passing it along to policyholders.

CMS saw the initial results and implemented a $35 premium increase cap(*). The OP's premium change from $12.30 to $47.30 reflects the $35 increase cap.

CMS Releases 2025 Medicare Part D Bid Information and Announces Premium Stabilization Demonstration | CMS

Today, the Centers for Medicare & Medicaid Services (CMS) is releasing preliminary technical Medicare Part D bid information for contract year 2025 to help Part D plan sponsors finalize their Part D and Medicare Advantage (MA) offerings and prepare for Medicare Open Enrollment. Additionally, CMS...

www.cms.gov

In TN, the Aetna SilverScript Choice plan has a $50.00 premium and $545 deductible this year. $47.30 premium and $590 deductible in 2025.

2025 Wellcare Value Script premium. I inserted the amounts.

Wellcare will continue to offer the Value Script Part D plans at zero premium in most states next year. Exceptions are AK [$22.30], CA [$17.40], CT [$12.40], MA [$12.40], NJ [$2.30], NY [$38.70], RI [$12.40] & VT [$12.40], where a premium will be charged. Copays are $0 on Tier 1 and $5 on Tier 2 generics at preferred pharmacies (CVS, Walgreen's, many Grocery Stores).

City-Data Forum - View Single Post - Wellcare Value Script Part D 2025

Post 67110561 - City-Data.com forum

www.city-data.com

(*) There was also a $15 reduction inside a CMS formula. It does not translate to a $15 premium reduction, just like the 6% increase cap that was a popular topic last year does not apply to the plan premium.

 

[RetMD21]

MBSC I have two questions.

If I can get my Wellcare for $0 in 2025 was I being overcharged at $0 in 2024?

Do some insurers just change existing plan premiums and coverage to take advantage of the customer's inertia?

 

[FiveDriver]

MB --
What is the Wellcare Value Script 2025 cost in South Carolina ??

 

[zekeboz]

I just got my 2025 Annual Notice of Change for my SilverScript Part D plan, and the rumors I heard about massive increases in plan D prices appear to be correct. My monthly premium amount is going from $12.30 to $47.30 and the deductible is increasing from $280 to $590. In addition, there are increases in co-payments for tier 1 and 2 drugs.

My understanding is these increases are a direct result of the Inflation Reduction Act which capped insulin prices and created an annual max out of pocket of $2000 for 2025 which is good, but apparently transferred a lot of those costs on to insurance companies which means everyone pays for it.

I'm curious to see what everyone else will see for premiums next year, and to see if my current plan will remain one of the least expensive in my area.

No surprise unfortunately…. One can not expect costs to rise with inflation when the whole industry is now based on a for profit model. I’ve been around long enough and know enough people in the field who long for the lost days of not measuring office visits in minutes, increasing bed turnovers or cutting back money losing services like EMS. I believe for all the virtues of capitalism this is one area that has been negatively affected and people’s health is at stake.