{"id":273456,"date":"2024-09-16T17:50:02","date_gmt":"2024-09-16T21:50:02","guid":{"rendered":"https:\/\/rarediseases.org\/?p=273456"},"modified":"2024-10-14T16:23:12","modified_gmt":"2024-10-14T20:23:12","slug":"medicare-ira-changes","status":"publish","type":"post","link":"https:\/\/rarediseases.org\/es\/medicare-ira-changes\/","title":{"rendered":"Changes to Medicare for 2025 and Beyond: Important Information for the Rare Disease Community Ahead of Open Enrollment"},"content":{"rendered":"

The National Organization for Rare Disorders (NORD) has <\/span>important information<\/span> to share with you <\/span>ahead <\/span>of<\/span> Medicare <\/span>O<\/span>pen <\/span>E<\/span>nrollment<\/span> as <\/span>two <\/span>new benefits of<\/span> the Inflation Reduction Act, or <\/span>IRA<\/span>, become available<\/span>. It is particularly important for the rare disease community as it affects how much you<\/span> may<\/span> pay for your medications if you <\/span>have<\/span> Medicare.<\/span><\/p>\n

1. There is now a $2,000 cap on your out-of-pocket prescription drug costs<\/strong><\/h2>\n

Beginning in 2025, a law called the Inflation Reduction Act (IRA) will make significant changes to Medicare prescription drug plans, also known as Part D plans. This law sets a yearly limit on how much you must pay for prescription drugs<\/span> at $2,000 for 2025. After that, the cap will change each year based on inflation. If your drug plan has a deductible, that money you pay for your deductible counts toward the $2,000 cap. For example, if your yearly deductible is $100, once you have paid that, you will only have to pay $1,900 more that year for your prescription drugs.<\/span>\u00a0<\/span><\/p>\n

This $2,000 cap only applies to drugs covered on your Medicare prescription drug (Part D) plan formulary and does not count towards therapies typically administered in your doctor\u2019s office or drugs that are not on your Medicare prescription drug plan formulary.<\/span><\/b> Drugs that are typically administered in your doctor\u2019s office are usually covered by Part B. The list of drugs that are covered by the drug plan is called the \u201cformulary.\u201d Drugs not covered by the plan are referred to as \u201cnot on formulary.\u201d (If the drug you take is \u201cnot on formulary,\u201d you still have options; scroll down to the FAQ for our recommendations.)<\/span>\u00a0<\/span><\/p>\n

Every year, during the annual Medicare Open Enrollment period from October 15-December 7 <\/strong>(which is different than the Medigap Open Enrollment period when you turn 65), it is extremely important to look at the Medicare prescription drug plans available to you and check which drugs a plan covers before you sign up. Make sure the prescription medications you take now, or expect to be taking in the upcoming year, are covered by the plan you choose. To check if a plan covers a drug you are currently taking, or expect to be taking in the upcoming year, go to the Medicare Plan Finder<\/a> on the Medicare.gov website.<\/strong><\/p>\n

Deciding on the right medication is a choice you make with your healthcare provider. During the Open Enrollment period, it is important to check if your current plan still covers the medicines you need and to carefully look at any new plan’s drug coverage, co-pays, and co-insurance.<\/span>\u00a0<\/span><\/p>\n

You can only choose a new plan once per year, with limited exceptions.<\/span>\u00a0<\/span><\/p>\n

2. You can pay for medicine in monthly installments, with a limit each month<\/strong><\/h2>\n

The IRA allows everyone with a Medicare drug plan to choose to join the monthly payment plan, either before the plan year starts or at any time during the year. This program is called the <\/span>Medicare<\/span><\/b> Prescription Payment Plan<\/span><\/b><\/a> (M3P) or \u201csmoothing.\u201d <\/span>You must sign up to utilize this option<\/span><\/b>.<\/span><\/p>\n

The Medicare Prescription Payment Plan is a great option for patients who have high drug costs early in the year. It may not work as well for patients who sign up for M3P later in the year or have high drug costs later in the year because there will be fewer months to spread out costs across to make monthly payments more manageable. The Medicare Prescription Payment Plan only covers out-of-pocket costs for prescription medications and does not include premiums.\u00a0<\/span>\u00a0<\/span><\/p>\n

Want to know more about if the Medicare Prescription Payment Plan might be the right option for you? Use the <\/span>Medicare Plan Finder website<\/span><\/a> or check out the <\/span>Medicare Prescription Payment Plan website<\/span><\/a> to find out more!<\/span>\u00a0<\/span><\/p>\n

NORD staff have recorded videos in English and Spanish explaining these changes in detail. Those who would prefer to watch or listen to those videos can access them on YouTube here<\/a>.<\/strong><\/p>\n

Frequently Asked Questions<\/h1>\n

Who is eligible for Medicare and how to enroll:<\/h4>\n

Medicare is health insurance for people 65 or older. You may be eligible to get Medicare earlier than age 65 if you have a disability, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS).\u00a0<\/span>\u00a0<\/span><\/p>\n

Medicare has multiple parts:<\/span><\/p>\n

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Part A<\/h6>\n
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Hospital Insurance<\/strong><\/h6>\n<\/div>\n