A new law will lead to changes in Medicare plans next year. People who have Medicare should prepare for these updates. 

The law, the Inflation Reduction Act, will mean that all Medicare enrollees will have the option* to pay out-of-pocket prescription drug costs as capped monthly installment payments. It allows members another option instead of paying all at once at the pharmacy. 

The Medicare open enrollment period* is a great time for members to begin planning for the changes and their health care needs for the new year. This year’s open enrollment period will be Oct. 15 to Dec. 7. 

What can I change during open enrollment? 

Medicare members can only join, switch or drop Medicare Advantage plans (Part C) or Medicare drug plan (Part D) at certain times. 

During the fall open enrollment period: 

• You can join, drop or switch to another Medicare Advantage plan. 
• You can also switch from Original Medicare to a Medicare Advantage plan or from a Medicare Advantage plan to Original Medicare. 
• You can join, drop or switch to another Medicare drug plan if you are on Original Medicare. 

All Medicare members should consider their options this year during the open enrollment period because of the changes to the new law. 

Why should I consider my plans for 2025? 

There are three things that will affect Medicare plans in the new year: 

1. Eliminating the donut hole for prescription drug coverage 
2. Creating a cap on covered prescription drugs at $2,000
3. Offering the ability to have copay smoothing on drug coinsurance.  

Let’s look at these updates. 

1. Eliminating the donut hole 

Medicare used to have a coverage gap* phase that was sometimes called the donut hole. This meant there was a temporary limit on what the drug plan covered for drugs. This gap will end Dec. 31, 2024.  

2. Creating the cap on prescription drugs 

The annual out-of-pocket costs for people with Medicare will be capped at $2,000 for prescription drugs covered by your plan. 

3. Offering copay smoothing 

Let’s say you have you an expensive prescription drug that costs $12,000 with a 25 percent coinsurance. Instead of paying $2,000 at once, you can spread that cost out over 12 months. 

The copay smoothing program is optional and not everyone will need to take advantage of it. To sign-up for the program, or to learn more about it, contact your Medicare Advantage plan’s customer service. 

How will this change my plan? 

Because of this, many Medicare plans will be changing in 2025. This means that your plan may not offer the same benefits or coverage. 

During Medicare open enrollment, you should compare plans* to make sure that your plan covers the drugs you take and meets your needs. 

If you already have Medicare, pay attention to your drug coverage to make sure you are not affected by these changes. If you take a medication regularly, you should verify that your plan will cover that medication in 2025. 

Your plan will notify you with a “Plan Annual Notice of Change”* document to say what will be different in your plan. You should receive this in September. If you didn’t receive this document, contact your plan. 

This document should help you decide if your current Medicare plan is the right fit for you. 

Why should I consider a Medicare Advantage plan? 

Medicare Advantage plans* are sometimes called “Part C.” Some Medicare Advantage plans include the Part D prescription drug plan. These plans offer a more comprehensive alternative to Original Medicare. 

BlueCross BlueShield of South Carolina’s Medicare Advantage plans offer several perks, including: 

• Fitness memberships.
• An over-the-counter benefits card with quarterly installments you can use on OTC items or healthy foods. 
• Vision, hearing and dental. 
• Care support with a dedicated nurse.  

Why choose BlueCross? 

BlueCross is the largest insurance company in South Carolina. When you enroll in a BlueCross plan, everyone who manages your plan is local. Our customer service team is right here in the state. Your calls are answered by South Carolinians. 

We have a five-star customer service rating, the highest score you can get. Our members love this because we are easier to work with. 

Our plan perks, such as dental, are a great reason to consider BlueCross. If you choose a BlueCross plan, you can be confident that we are here to help. 

How can I get help with understanding my benefits? 

Visit our website to learn more about what options are available to you.  

But if you prefer to talk to a person, you can call us at 1-800-930-2836 (TTY: 711). Our team is available to help you find the best plan for your needs. 

You can also visit one of our retail stores in Charleston, Columbia, Greenville and Myrtle Beach for in-person help. 

*These links lead to third-party websites. Those organizations are solely responsible for the contents and privacy policies on their sites.

TL;DR:

A new Medicare law will make plans simpler in 2025 that will allow members to better budget for their drug spend over the year. Compare plans during the open enrollment period to ensure your Medicare plan will meet your needs in the new year. 

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