Medicare Corner
This project was supported in part by grant number 90MPPG0022, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy. Drug Formulary: Make sure that you are getting the most cost-effective coverage for your prescription medication. Beginning this year, prescription out-of-pocket costs will be capped at $2,000. This is a huge reduction from last year’s $8,000. Also available this year is the Prescription Payment Plan Program which allows beneficiaries to set up a twelve-month payment plan for medications. Once enrolled in either Medicare Advantage or Standalone Part D Plan, coverage will take effect on the first of the month following enrollment. For additional assistance, contact your local State Health Assistance Program at 1-800-435-4040. Pima Council on Aging is the local SHIP for Pima County. Contact us at (520) 546-2011 or email us at SHIP@pcoa.org. Maximum Out of Pocket (MOOP) Costs: This is the maximum amount you will be responsible for before the plan picks up the total cost of your care. This amount varies by plan. In 2025, MOOP costs for Pima County plans range from $2,400 to $11,500. Plan Network: Confirm with your existing providers that they are contracted with the plan that you are considering. Also note that Health Maintenance Organization (HMO) plans may require a referral from a PCP to see specialists while Preferred Provider Organization (PPO) plans typically do not. HMO Point-of-Service may have flexibility in some parts of their coverage. Check with the plan directly for accurate information. What to Know About Medicare Advantage Open Enrollment Period Medicare Advantage Plans (also known as Part C) and standalone Prescription Plans (also known as Part D) are run by private companies. For Medicare beneficiaries enrolled in Medicare Advantage, Open Enrollment resumes on January 1st to March 31st. During this period, Medicare Advantage enrollees can: • Switch to another Medicare Advantage plan with or without drug coverage. In 2025, Pima County has forty-seven Medicare Advantage Plans that include drug coverage, and eight plans without. • Drop the Medicare Advantage Plan and return to Original Medicare. This also allows you to join a separate, standalone, Medicare drug plan. Enrollees will have a choice of twelve standalone plans. However, Original Medicare enrollees cannot switch to Medicare Advantage at this time. Some important factors to consider when switching to Medicare Advantage Plan include:
Page 10 | January/February 2025, Never Too Late
Pima Council on Aging
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