Aetna Medicare Plan
Please read below about important changes to your Aetna Medicare Advantage plan for 2025. You may have seen on the news that the Center for Medicare Services has made many changes to prescription drug programs for seniors that will be effective for 2025. A brief overview of the most impactful changes to the plan are below and you will receive materials later this fall from Aetna with greater details. Please review these updates carefully as they will impact your health care coverage and costs:
New Prescription Drug Out-of-Pocket Cap
Beginning in 2025, there will be a $2,000 ($8,000 previously) cap on out-of-pocket costs for prescription medications under Part D. This change could greatly reduce your annual expenses for prescription drugs. There is no more Part D “donut hole” or coverage gap. This change simplifies the way Part D works. Below is an example of how this change will work:
|
Prescription
|
Member Pays
|
Plan Pays
|
Out of Pocket
|
|
First Fill
|
$35.00
|
$657.50
|
$692.50
|
|
Second Fill
|
$35.00
|
$215.00
|
$250.00
|
|
Third Fill
|
$35.00
|
$215.00
|
$250.00
|
|
Fourth Fill
|
$35.00
|
$215.00
|
$250.00
|
|
Fifth Fill
|
$35.00
|
$215.00
|
$250.00
|
|
Sixth Fill
|
$35.00
|
$215.00
|
$250.00
|
|
Seventh Fill
|
$35.00
|
$22.50
|
$57.50
|
|
Total
|
$245.00
|
$1,755.00
|
$2,000.00
|
|
*Last year the member would pay up until the $8,000 out of pocket max, and this year both the member and plan add up to a new out of pocket max of $2,000
*The table above is one possible illustration and not predictive of all prescriptions
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Some additional changes are:
- Monthly Payment Plan for Prescription Costs
- Manufacturer Discount Program
- Midyear Coverage Notices
- Stricter Marketing Rules
- Expanded Benefits for Family Caregivers
- Improved Access to Mental Health Providers
