Help! My 2025 Medicare Part D Plan Doesn’t Cover My Lifesaving Insulin!
Toni,
In 2022, the ToniSays Medicare team enrolled me in a Medicare Supplement and Medicare Part D plan, including my prescriptions with co-pay only. On Friday, I looked online at Medicare.gov and noticed something shocking. My diabetic insulin, which I’ve had since 2022, will no longer be covered. Now, it’ll cost $391 monthly out-of-pocket. Ozempic, which has a $11 co-pay, is a Tier 5 drug costing $238 per month with NO co-pay for 2025.
With Ozempic and my monthly meds, I meet the $2,000 maximum out-of-pocket in February, paying $0 for the rest of the year except for the $391 for my monthly insulin. How can I find a 2025 Part D plan that covers my insulin and change the Part D plan before the AEP (Annual Enrollment Period) ends on December 7th?
Thanks,
Tabitha from Lubbock, TX
Tabitha,
Sadly, this is an all-too-common problem. In fact, the Toni Says phones began exploding after the AEP started on October 15th. Other Americans like you—with specific brand drugs such as Ozempic, Mounjaro, or diabetic insulins and other drugs—are receiving higher drug costs or not being covered. This problem also occurs with Medicare Advantage plans.
However, don’t fret. I have some advice that might help you and others in your situation.
Step One: Open a Medicare.gov account.
Tabitha, enrolling in a Medicare Part D or Medicare Advantage with Part D plan online requires you to open a www.medicare.gov account. You’ve already done this since you were able to view:
- What your prescription co-pays were
- The tiers Ozempic was placed in
- The cost of your insulin now that it’s no longer covered under your 2024 Medicare Part D plan.
For those of you who don’t have an account on Medicare.gov, opening one is simple.
1. Navigate to https://www.medicare.gov/account/create-account and follow the three steps to create your online account!
If you don’t have your Medicare card, you can get your Medicare Number by logging in to your Social Security account. If you need more help, you can call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Step Two: Change Your Part D or Medicare Advantage Part D plan through the online portal!
Fortunately, changing to a 2025 Medicare Part D or Medicare Advantage Part D plan is easy! Here’s a simple step-by-step explanation.
1. Log into your www.medicare.gov account and click on “Find health and drug plans.”
2. Verify your “extra help” (based on income).
Also, list the pharmacies you prefer. Under “Your Drug List,” list ALL of your drugs. Please enter the prescriptions into the system every month rather than on a 3-month or 6-month basis, because of Medicare’s new $2000 out-of-pocket maximum rule. Monthly rates let you know when you will qualify for the $2000 out-of-pocket maximum and no longer have to pay the deductible or copay for the rest of the year. (When drugs are input quarterly, the $2,000 limit is not easy to find.)
3. Click on “Find Plan Now” and click “2025” to find 2025 Part D or Medicare Advantage plans.
Note: ONLY click “2024” if you are new to Medicare and enrolling in Part D for the first time for a December 2024 start.
4. Select which plan you wish to enroll in by checking either Medicare Advantage or Medicare Part D (standalone).
Tabitha, your current enrolled plan will show up first with the 2025 premium. The plans listed after your plan are rated from the least out-of-pocket to the most out-of-pocket on the Medicare.gov site.
5. Search the prescription drug plans below the current plan to find which Part D plan covers the insulin at the lowest co-pay, including your prescriptions and Ozempic.
Take your time exploring options and the plan that meets your prescription and financial needs whether choosing a stand-alone Medicare Part D or Medicare Advantage plan. Under the section titled “Estimated Total Monthly Drug Cost”, it will show when you meet the $2,000 out-of-pocket drug cost. Those with low drug costs and low co-pays do NOT have to meet the $2,000 out-of-pocket if the monthly cost is lower.
More Medicare Resources
Readers, you will want to take these steps to ensure you sign up for your Medicare Part D plan BEFORE the AEP ends on December 7th. Call the Toni Says Medicare hotline for Medicare help at (832)-519-8664 or email your Medicare question to [email protected].
Medicare decisions can be overwhelming, but resources are available to help:
- Visit Medicare.gov: Explore tools and information to compare plans.
- Seek Expert Guidance: Reach out to trusted advisors who specialize in Medicare to customize a plan for your needs.
- Engage Family Support: If navigating Medicare feels overwhelming, involve trusted family members to assist with decisions and research.
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Originally published November 19, 2024
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