Out-of-pocket costs for prescription meds will drop from $8K to $2K in 2025
The annual Medicare Open Enrollment Period runs from October 15, 2024, to December 7, 2024. Additionally, the State Health Insurance Marketplace Open Enrollment Period takes place from November 1, 2024, to December 15, 2024, with some states extending it to January 15, 2025.
Why is this fall’s Medicare Open Enrollment Period (OEP) especially important?
Starting in 2025, the annual out-of-pocket limit for all Medicare-covered prescription drugs will drop significantly from $8,000 to $2,000. This means that no matter how many medications you need, you won’t pay more than $2,000 for your prescriptions in a year. The $2,000 cap coupled with the ability to spread out payments means that high out-of-pocket costs many refer to “Donut Hole” are gone in 2025.
Next, make sure to check if you can receive full Extra Help assistance. Beginning in 2024, if you are single with monthly income up to $1,883, or a couple with monthly income up to $2,555, you could qualify for Extra Help which covers most of your prescription drug costs such as deductibles and copayments as well as premiums.
If I am under 65 and uninsured, but not yet eligible for Medicare, can I still enroll in a health plan?
Yes, anyone who is uninsured and not yet eligible for Medicare can sign up for health insurance during the Affordable Care Act (ACA) Open Enrollment Period (OEP). This period is also a great chance for people who missed signing up during their Special Enrollment Period (SEP), which may have been offered to them after reporting specific life events such as marriage, childbirth, or job loss.
For 2025, OEP runs from November 1, 2024, to December 31, 2024 (or January 15, 2025, depending on your state). If you apply for a health plan and select your plan within this time window, your new plan will begin on January 1, 2025 (or February 1, 2025).
During this period, you can explore various health plan options through the state’s Health Insurance Marketplace. If you are single with an annual income under $60,240, or if you’re a married couple earning less than $81,760 per year, you may be eligible to lower your premiums or out-of-pocket costs based on a sliding scale. If your income is low enough, you might also qualify for Medicaid.
It’s important to check your state’s specific dates and enrollment guidelines to ensure you don’t miss the opportunity.
I haven’t heard much news about COVID-19 these days, but do I still need to get vaccinated?
COVID-19 is still a serious health risk, causing thousands of hospitalizations and deaths each year. According to the CDC (Centers for Disease Control and Prevention), from October 1, 2023, through June 1, 2024, approximately 44,000 people died from COVID-19 in the U.S.
Immunity acquired from vaccination or prior infection may decrease over time, and new variants of the virus can make earlier vaccines less effective. This is why it’s recommended to get the COVID-19 vaccine each year, like flu shot, to protect yourself and your loved ones.
If you have questions about public benefits, there are three ways you can reach us today:
-Call: (English) 1-800-336-2722, (Chinese Mandarin) 1-800-683-7427, (Chinese Cantonese) 1-800-582-4218, (Korean) 1-800-582-4259, (Vietnamese) 1-800-582-4336
-Email: askNAPCA@napca.org
-Mail: NAPCA Senior Assistance Center, 1511 3rd Avenue, Suite 914, Seattle, WA 98101
National Asian Pacific Center on Aging (NAPCA) is a non-profit organization dedicated to improving the quality of life of AANHPI older adults and their families.
