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Prescription drug coverage is changing in 2025

The coverage gap (or “donut hole”) stage is being removed, and the out-of-pocket maximum will be lowered to $2,000. You can count on us to help you understand what those changes mean to you.

Learn more

Video transcript

0:00 Hello.

0:01 As a Medicare provider with over 45 years of experience,

0:05 you can count on, UnitedHealthcare understands that Medicare coverage

0:09 is personal and changes to your coverage can affect your life.

0:13 That's why we want to keep you in the know about some changes

0:15 brought by the federal government

0:17 impacting all standalone Medicare prescription drug plans

0:21 and Medicare Advantage plans with prescription drug coverage in 2025.

0:26 Let's get started.

0:27 We'll cover three big updates.

0:30 Removal of the coverage gap, a lower

0:32 maximum out-of-pocket amount for prescription drugs,

0:36 and a new prescription payment plan option.

0:41 First, good news. In 2025,

0:43 the coverage gap, also called the donut hole, has been removed.

0:47 There are now three Part D prescription drug coverage stages: an annual

0:52 deductible stage, initial coverage stage

0:56 and catastrophic coverage stage.

0:59 If a plan has a prescription drug deductible, members will be responsible

1:02 for paying the full cost of their drugs until they reach this amount.

1:07 Then, in the initial coverage stage, they will be responsible for paying copays

1:11 or co-insurance once the member and others on their behalf

1:15 have paid a combined total of $2,000 for Medicare covered medications,

1:20 including any amount toward the deductible.

1:22 The member moves straight into the catastrophic coverage stage

1:26 where they will pay $0 for Medicare covered Part D drugs

1:30 for the remainder of the plan year.

1:33 See more coverage.

1:35 No gap. In 2024,

1:38 for all Medicare members, no matter what insurance provider

1:40 they were enrolled with, the Part D out-of-pocket max

1:44 was $8,000. In 2025,

1:47 the out-of-pocket max is lower than ever.

1:50 Once a member and others on their behalf have paid a combined total of $2,000,

1:54 they'll pay nothing for Medicare covered Part D prescription drugs

1:58 for the rest of the plan year.

2:01 However, while the goal is to lower prescription drug expenses, these changes

2:05 could result in higher deductibles or premiums in 2025.

2:10 This means members may pay more earlier in the year during the deductible stage,

2:14 but could see an overall savings compared to prior years

2:18 with the lowered out-of-pocket maximum.

2:20 Also for 2025, there's a new optional program

2:24 called the Medicare Prescription Payment Plan.

2:27 Instead of paying all your out-of-pocket costs

2:30 when you fill your prescriptions at a network pharmacy,

2:33 you can spread these payments out over the plan year with monthly bills.

2:38 It's important to know this program does not lower prescription drug costs.

2:43 The payment amount may change each month until you reach the $2,000

2:47 out-of-pocket max.

2:48 So while monthly payments may be more manageable,

2:51 they may also be less predictable.

2:53 Your plan's sponsor may contact you if you're likely to benefit

2:57 from the program.

2:58 For any questions or to find the right UnitedHealthcare plan for you.

3:03 Chat with a Medicare plan expert live on

3:07 UHC.com/Medicare.

3:10 No matter the changes, UnitedHealthcare

3:12 offers reliable coverage you can count on for your whole life ahead.

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“With UnitedHealthcare, if they say a provider’s
in-network, the provider’s in-network.

If they say something’s going to be covered,
it’s going to be covered.

So that to me is the definition of reliability.”

– Charlene B., UnitedHealthcare Medicare Advantage Member

4 out of 5 members recommend UnitedHealthcare Medicare Advantage plans.

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. A Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Benefits, features and/or devices may vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Provider network may vary in local market. Provider network size based on Zelis Network360, May 2024. Most chosen based on total plan enrollment from CMS Enrollment Data, May 2024. Member recommendations based on Human8, May 2023. Requests to disenroll or change plans remain subject to applicable Medicare regulations and Federal and state laws/regulations.

Last updated: 08.21.24 at 12:00 A.M. CT | Y0066_240812_034929_M