Medicare open enrollment is on the horizon. Now is the time to start thinking about any changes you may want to make to your Medicare coverage. Thanks to the Inflation Reduction Act, some significant changes have come along for Medicare and more will take effect in the near future.
Medicare Open Enrollment
Medicare open enrollment happens once each year. In 2024, the open enrollment period is between October 15 and December 7. Any changes to your Medicare plans will take effect on January 1, 2025. During the open enrollment period, you can:
- Join or drop a Medicare Advantage Plan, switch between Medicare Advantage Plans, or add or drop Medicare prescription coverage.
- Switch from Original Medicare to a Medicare Advantage Plan or vice versa.
- Join or drop a Medicare prescription drug plan, or switch to a different drug plan if you are enrolled in Original Medicare.
If you are already in a Medicare Advantage Plan, you will also have an open enrollment period between January 1 and March 31 of 2025, during which you can:
- switch to another Medicare Advantage Plan (with or without drug coverage);
- drop your Medicare Advantage Plan and return to Original Medicare; or
- join a separate Medicare drug plan.
Learn more about Medicare enrollment periods and how to join the various plans.
Lower Drug Prices for Medicare Members
One of the most significant changes Medicare beneficiaries will see in the coming years is the lowering of prescription drug prices. Under the Inflation Reduction Act (IRA), the federal government was granted the authority to negotiate the prices of certain high-cost medications covered under Medicare. This historic move is designed to reduce out-of-pocket expenses for beneficiaries and lower costs for the Medicare system.
In 2026, the first round of negotiated prices will take effect, affecting the cost of 10 widely used prescription drugs. These drugs were chosen because of their high cost, they are each available only from single sources, and there are no generic or biosimilar competitors.
The following chart outlines the initial 10 drugs that will be affected by the lower negotiated prices. The prices in the chart are rounded and represent estimates of the Wholesale Acquisition Costs (WACs) based on a 30-day supply in calendar year 2022.
The manufacturers of the drugs are participating in the Negotiation Program voluntarily. The below information is subject to change. Learn more on the Centers for Medicare & Medicaid Services (CMS) website.
| Drug Name | Commonly Treated Condition | List Price for 30-Day Supply in 2023 | Discount of Negotiated Price From 2023 List Price | Agreed-to Negotiated Price for 30-Day Supply for 2026 |
|---|---|---|---|---|
| Januvia | Diabetes | $527 | 79% | $113 |
| Fiasp, Fiasp FlexTouch, Fiasp PenFill, NovoLog, NovoLog FlexPen, NovoLog PenFill | Diabetes | $495 | 76% | $119 |
| Farxiga | Diabetes, Heart failure, Chronic kidney disease | $556 | 68% | $178.50 |
| Enbrel | Rheumatoid arthritis, Psoriasis, Psoriatic arthritis | $7,106 | 67% | $2,355 |
| Jardiance | Diabetes, Heart Failure, Chronic kidney disease | $573 | 66% | $197 |
| Stelara | Psoriasis, Psoriatic arthritis, Crohn’s disease, Ulcerative colitis | $13,836 | 66% | $4,695 |
| Xarelto | Prevention and treatment of blood clots, Reduction of risk for patients with coronary or peripheral artery disease | $517 | 62% | $197 |
| Eliquis | Prevention and treatment of blood clots | $521 | 56% | $231 |
| Entresto | Heart failure | $628 | 53% | $295 |
| Imbruvia | Blood cancers | $14,934 | 38% | $9,319 |
If you take any of these 10 drugs, you will want to monitor developments closely. Keep in mind the lower prices will not take effect until 2026. Planning ahead can help you anticipate future savings and make informed decisions during the 2025 open enrollment period.
In addition to the 10 drugs listed above, the CMS will pick 15 more drugs by February 1, 2025, that are covered under Medicare Part D to negotiate lower prices for, starting in 2027. For 2028, CMS will negotiate lower prices for 15 more drugs that are covered by Medicare Part B and Part D. Up to 20 more Part B and Part D drugs will be chosen for lower negotiated prices each year after 2028.
Americans are Still Paying More for Medications
Even with these discounts, Americans are still paying more for brand-name prescription medications than people in most other countries. According to The Commonwealth Fund, Americans’ per capita spending on pharmaceuticals is nearly three times the average of citizens of other Organisation for Economic Co-operation and Development (OECD) nations.
A 2022 study published by JAMA found that about a fifth of U.S. adults over the age of 65 were trying to reduce their prescription drug costs by skipping or delaying filling their prescriptions, reducing or skipping doses, or using another person’s medication. Some survey respondents said they had to forgo basic needs or start accruing debt so they could afford their medications. Such desperate measures can have serious consequences for people with chronic health conditions.
More Changes Coming to Medicare
The IRA offers additional changes that will help Medicare beneficiaries on other fronts as well.
- Medicare beneficiaries will have a yearly cap on how much they will have to spend on out-of-pocket prescription drugs covered by Medicare. The cap for 2025 is to be set at $2,000.
- Insulin costs are capped at $35 per month per covered prescription for those who are enrolled in Medicare Part D. This cap may not apply to all insulin products. Check with your care provider to determine whether this applies to you.
- Recommended vaccines will be available at no cost to people who have Medicare prescription drug coverage.
- The Medicare Part D low-income subsidy program (LIS), also known as Extra Help, has been expanded to 150 percent of the federal poverty level (FPL). If your annual income is 150 percent of the FPL, then you may qualify for the Extra Help program.
- Companies that raise the prices of certain drugs faster than the rate of inflation must pay a rebate to Medicare.
Learn More About Medicare and Late-Life Planning
As is typical of health insurance and health care, Medicare and its related plans have nuances. Speak with a health care professional or an experienced elder law attorney near you. They can discuss your specific situation and potential options with you.
For additional reading on Medicare and late-life planning, check out the following articles:
- Medicare Part D Plans 2024: Prescription Drug Coverage
- Pay Monthly for Medicare Part D Prescriptions Come 2025
- Medicare Advantage: An Alternative to Original Medicare
- Why Hire an Elder Law Attorney?