FAQs: 2025 Medicare and Marketplace Changes
Get answers to frequently asked questions about the new changes to Medicare Part D and Marketplace Insurance.
Q: What is the new out-of-pocket cost cap for Medicare Part D?
A: Starting in 2025, Medicare Part D will limit your out-of-pocket costs for prescription drugs covered by Part D at $2,000 per year. While this includes drugs from in-network pharmacies, those from out-of-network pharmacies may not be included, depending on your insurance plan. Be sure to check before using an out-of-network pharmacy.
Q: How does the spread-out payment option work?
A: You must choose to opt in to the Medicare Prescription Payment Plan. Instead of paying a large amount at one time for your medications, this will allow you to spread the payments over the year, especially if you sign up at the beginning of the year. This can help you manage your budget better.
Q: Will vaccines be free?
A: Yes, starting in 2025, all adult vaccines recommended by the Centers for Disease Control and Prevention will be free, meaning no out-of-pocket costs for you. That includes COVID-19, flu, pneumonia, RSV and shingles vaccines.
Q: How will the drug price negotiations affect me?
A: Medicare negotiating drug prices aims to lower the cost of some high-priced medications, making them more affordable for you beginning in 2026. Ten drugs, including Stelara and Enbrel, are being negotiated in the first year. More are expected in future years.
Q: How are Marketplace plans changing?
A: Premium subsidies, enhanced in 2021, will continue through 2025, which helps lower your health insurance costs. There are also new benefits in other health areas, such as basic dental coverage. Read some sample scenarios.
For more information, visit arthritis.org or contact our Helpline at 800-283-7800. We’re here to help you navigate these changes and find the best plan for your needs.
Always check with your insurance provider for the most accurate and personalized information.