Important Medicare Part D Changes: What Autoimmune Patients Need to Know This Enrollment Period

As Medicare’s open enrollment period approaches, it’s important for patients living with autoimmune diseases to be aware of new changes to Medicare Part D. Many autoimmune patients rely on prescription drugs for disease management, and updates to the program could significantly impact your costs and coverage. Here’s what you need to know to make informed decisions about your healthcare.

Changes to Medicare Part D This Enrollment Period

The annual Medicare open enrollment period runs from October 15 to December 7 each year.

With open enrollment upon us, there are a few changes to the prescription drug benefit program that individuals should be aware of when selecting their plan for the upcoming year.

Since its creation in 2006, Medicare’s Part D benefit has expanded to provide prescription drug coverage for 51 million of the 65 million Medicare enrollees. The Inflation Reduction Act (IRA), signed into law in 2022 by President Biden, introduces a $2,000 out-of-pocket (OOP) cap on Medicare Part D prescription drug costs, effective January 1, 2025. The IRA will also allow Part D enrollees to spread their OOP costs throughout the year rather than paying them all at once. This new plan is called the Medicare Prescription Payment Plan (MPPP) or the OOP Smoothing Program. The United States Department of Health and Human Services (HHS) estimates these policy changes will result in a $7.4 billion reduction in annual out-of-pocket spending for 18.7 million enrollees.

Why This Matters for Autoimmune Patients

For autoimmune patients, staying on top of medication is vital for disease management, and the rising cost of prescriptions is a common concern. The new out-of-pocket cap will provide much-needed financial relief, especially for those who require expensive specialty medications. Being able to spread payments over the year could also ease financial strain, ensuring that you can maintain access to the treatments you need without the burden of a lump-sum payment.

How to Join a Medicare Health or Drug Plan

[From Medicare.gov]

• Find out which plans are available in your area
  • Compare plans in your area – Find out what they cost and what services they provide. Enter the prescription drugs you take to get an estimate of your monthly and yearly costs for each plan.
  • Use your “Medicare & You” handbook – Plans are listed in the back.
  • Talk to a trusted agent or broker – Check the rules they must follow.
  • Contact your local State Health Insurance Assistance Program (SHIP) to get free personalized health insurance counseling. SHIPs aren’t connected to any insurance company or health plan.
• Make sure the plan meets your needs
  • Check if the plan covers your prescriptions and includes the benefits you need.
  • Ask your doctors if they’re in the plan’s network.
  • Review costs, including monthly premiums, deductibles, and an estimate of your yearly costs for drugs you take.
  • If you have other health insurance or drug coverage, consult your benefits administrator or insurance provider before making changes to your current coverage.
  •  If you live in another state part of the year, check whether the plan covers you there.
• Join the plan. Once you’ve chosen a plan, you can:
  • Select “Enroll” for the plan you want to join.
  • Contact the plan directly by phone or on their website. You can also request a paper enrollment form, but it must be submitted before the enrollment period ends.
  • Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.

Learn More

Learn more about Medicare health plans and drug coverage (Part D).

Key Terms

• Medicare: A federal health insurance program for people aged 65 or older and certain younger individuals with disabilities.
• Medicare Part D: A federal program that helps seniors and individuals with long-term disabilities who are Medicare beneficiaries pay for self-administered prescription drugs.

Take Action During Open Enrollment

For autoimmune patients who depend on prescription medications, the updates to Medicare Part D could have a significant impact on both your health and finances. As open enrollment approaches, review your options carefully and make sure you choose a plan that meets your needs. Whether you’re looking for better coverage for your specific prescriptions or need help managing out-of-pocket costs, these changes offer new opportunities for savings and smoother payment options. Be sure to take advantage of the enrollment period to secure the best coverage for your ongoing treatment and healthcare needs.

For More Information

For an in-depth patient guide, please review this resource from our partners at MAPRx.