Comparing Part D Drug Plans for 2025 Is More Important Than Ever

People with kidney failure who are on dialysis or have kidney transplants take a lot of medications. One study of U.S. patients from 2013-2017 reported HD patients took a mean of 6.8 different medications daily, with 73.8% taking >5 meds daily.¹ Although Medicare Part B covers some medications in the ESRD Prospective Payment System (bundle), most drugs that dialysis patients need are covered by Part D—not Part B. The US Renal Data System reported in 2023 that 83.1% of HD patients and 72.5% of PD patients had Part D in 2021.²

Each year the U.S. government reminds people with Medicare to review and compare their drug coverage in Medicare Advantage and stand-alone Part D plans. In 2025, some plans are merging, while others are being discontinued. Patients should have received an Annual Notice of Change (ANOC) alerting them to this—but some may not have read or understood it. So, I’m going to try to explain this complex program.

What Medicare Changes in 2025 May Help Patients Save Money on Drugs?

• New cap on out-of-pocket drug costs. Starting in January 2025, stand-alone Part D plans and Part D in Medicare Advantage (MA) plans will have a $2,000 cap on out-of-pocket drug costs. Once a patient pays $2000, all other plan-covered drugs in 2025 will be free. This makes it vital for patients to compare plans to see which of their drugs are covered. Drugs covered by a patient’s plan this year may not be covered in 2025 and the same drugs may cost less—or more.



• Medicare Prescription Payment Plan (M3P). M3P allows patients to spread out their costs until they reach the $2000 limit. Since people who can’t afford their drugs often skip, split pills, or space them out risking their health, the goal of M3P is to make it easier for people to afford take their prescribed drugs as ordered.³ Plans must contact all members who pay a lot for drugs to tell them about M3P. Patients can sign up for M3P by phone, mail, or online through their plan. Those who sign up won’t pay for their drugs at the pharmacy. Their stand-alone Part D or MA plan will bill them monthly for the plan premium and drug costs. How much a patient pays per month will depend on which drugs they take, how many they get, and when they sign up for M3P. This video describes M3P.

• Part B covers insulin pump insulin at $35 a month with no deductible. Patients can have Original Medicare or MA plans. Insulin in a stand-alone Part D or MA plan with drug coverage is capped at $35 for a one-month supply; a 3-month supply should cost no more than $105.⁴ Patients should review their Part D plan’s drug list to make sure it covers the insulin they take.

When Can Patients Compare Medicare & Drug Plans?

From October 15 to December 7 each year, patients can add, switch or drop their Medicare health or drug plan. Patients who are thinking about dropping their plan need to know that there is a premium penalty for any months they don’t have drug coverage that is as good as Part D. So, if cost is a concern, check out the section of this blog that talks about ways to pay for drugs. Patients might want to drop their health or drug plan if they have coverage a different way, such as through a new job or as a spouse or a dependent.

How Can Patients Compare Medicare Health & Drug Plans?

Patients who want to compare their plan to other plans or to look at plans for the first time can do this in one of two ways:

1. Contact the state health insurance assistance program (SHIP). Each state has a SHIP.

• Patients who do go online can call the SHIP National Technical Center office toll-free at (877) 839-2675. SHIP counselors are trained and certified to be Medicare experts. They are unbiased, not paid by insurance companies, and do not sell plans. They can help patients look at their drug list and review plans that cover most or all of their drugs while looking at costs and pharmacies. Watch a short video about what they do here.

• Patients who go online can visit the SHIP website and click SHIP Locator to find local help.

2. Call 1-800-MEDICARE (1-800-633-4227) and talk to a counselor or visit Medicare.gov. Patients who go online can either:

• Create an Account. When a patient logs in with an ID and password (the website will verify identification) and checks that s/he just wants to see Part D plan options, the program will show the current Part D plan first and list other plans to compare by lowest premium and drug cost (combined). The patient can choose to change the sort to see plans with the lowest yearly drug deductible or premiums. If s/he entered a drug list and/or took drugs under Part D in 2024, the site lists the drug, dose, quantity, and pharmacies from 2024. Plan information includes the premium, drug & premium cost (for 2025), and deductible (default setting). Using links to View your pharmacies and View your drugs and their costs, patients can add up to five pharmacies and match their drug lists to what they take now. Patients may want to ask their doctors what drugs they may need to take next year if they change to a different treatment or have health changes. (NOTE: I’d copy the page, but the type would be too small to read.)

• Click Find Health & Drug Plans to see the page below without logging in. Patients new to Part D can review new plans by choosing 2025 and entering their zip code. They can learn what drugs are covered and what they will cost if they enter each drug, dosage, and quantity they take for one or more months.

The patient will then see a screen that gives the option to look at MA plans, Medicare drug plans (Part D), or Medigap plans in their zip code. If a patient chooses Part D, the next screen will ask if s/he gets help with Medicare or drug costs, i.e., Medicaid, Supplemental Security Income, Medicare Savings Program, Extra Help (with drug costs) or can check I don’t get help from any of these programs. The program will then tell them which plans are in their zip code. The only way to know what costs will be with any plan is to enter the drug(s), dosage, and quantity as mentioned before.

What About Medicare Advantage (MA) Plans?

A note at the top of the drug plans page shows how many MA plans serve the patient’s zip code. Those who can’t get Medicaid or a Medigap plan in their state may want to look for the MA plan that covers providers and drugs at a nearby pharmacies. In the list of plans, there is an option to Select a Plan Type (MA or Part D), which gives patients another chance to say whether they want to see Part D plans or MA plans.

What Should Patients Consider When They Review Current or New Plans?

For patients who have a Part D plan, Medicare suggests considering these things:

• Are your benefits changing?

• Is your prescription drug coverage changing?

• Will your pharmacies still be in-network?

• Is your premium or deductible changing?

• Are your copayments or coinsurance changing?

• Is there coverage you need, that your current plan doesn't offer?

• Are you happy with your current plan?

How Can Patients Be Sure that What They Read on a Part D or MA Plan Website Is Accurate?

MA plans have gotten in hot water over misleading advertising and brokers have been banned.

It’s important for patients to call 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov to look at plans before they choose a Part D or MA plan to be sure the premium, deductible, and drug costs are the same as what they see on a Part D or MA company’s site. If there are differences, patients should contact the company selling the Part D or MA plan to ask about them.

Patients who are considering an MA plan should visit the company’s website and look for the provider directory to check to be sure that all of their preferred providers and hospitals are in the plan’s network.. They should look for the drug list (formulary) to be sure their drugs are covered and how they’re covered. They need to know what benefits, including “extra benefits” MA plans provide and what, if any, limits plans have for those benefits.

How Does a Patient Enroll in a New Health (MA) or Part D Plan?

When patients feel like they’ve done enough research, those who do nothing will stay in their 2024 plans. Patients who want to join or switch plans can do one of three things:

1. Call 1-800-Medicare

2. Join on the new plan’s website

3. Call the new plan

Enrolling in a new plan will end coverage under the old plan at midnight on 12/31/2024. The new plan will start at 12:01 a.m. on 1/1/2025. Patients who switch plans will get new cards. They need to alert all of their providers about the new plan, and they want to use a different pharmacy, providers need to know that too.

Where Can Patients Turn for Help with Premiums and/or Drug Costs?

Medicare.gov talks about 5 ways patients can save money on prescribed drugs.⁵

1. Apply for Extra Help. The Medicare page still lists 2024 dollar amounts, which will change in 2025. Extra help provides a premium-free plan with low copays.

2. Consider generic or lower-cost drugs. Patients can ask their doctors about options.

3. Pharmaceutical Assistance Programs are offered by drug makers to people who meet their guidelines and take certain drugs.

4. State Pharmaceutical Assistance Programs are available in some states.

5. The Medicare Prescription Payment Play (M3P) mentioned earlier.

Other resources patients can use if costs in the Part D plan are too high include:

• Cost Plus Drugs is Mark Cuban’s drug program

• GoodRx

• The following charities and/or nonprofit organizations may help patients with certain health conditions who take certain drugs and meet their financial guidelines:

  • Accessia Health 800-366-7741

  • CancerCare 866-55-COPAY

  • Good Days 877-968-7233

  • Healthwell Foundation 800-675-8416

  • National Organization for Rare Disorders 800-999-6673

  • Needy Meds 800-503-6897

  • PAN Foundation 866-316-7263

  • The Assistance Fund 855-845-3663

NOTE: The $2000 per-year cap that starts in 2025 is only for drugs obtained through a patient’s stand-alone Part D plan or MA plan with drug coverage.

Conclusion: Don’t Miss the SHIP

There are many options for health and drug coverage. Reviewing plans can feel overwhelming and some patients may choose not to do it. But, failure to review plans can risk patients’ physical and financial health, especially when there are changes in 2025. Time is of the essence. The clock is ticking and December 7 will be here sooner than any of us expect. If you’re reading this blog as a professional working with patients on home dialysis or you are a home patient or loved one, there is an easy way to get the advice you need to do a thorough review: encourage patients to contact their state health insurance assistance program (SHIP) for FREE counseling. I provided a link and a video above.

Insurance companies and brokers have a bias: they are paid when a patient enrolls in a plan they recommend. Some may not offer patients all options. On the other hand, SHIP staff and volunteers are trained and certified as Medicare experts, SHIP counseling is free, and SHIPs are located in every state and government-funded to provide free, full, and unbiased information to people with Medicare about Part D and much more. SHIP counselors have the expertise and want to help! They can meet your patients in person or by phone or computer.