My pharmacy told me I don’t have to pay for my medicine anymore this year because I’ve reached the cap of my drug plan. But I haven’t spent $2,000 yet. How can that be?

Starting in 2025, Medicare set a limit of $2,000 on how much people pay out of pocket for covered prescription drugs each year. This limit applies to any Medicare drug plan you have, whether it’s stand-alone or part of a Medicare Advantage plan. The $2,000 cap includes everything you pay for covered medications—such as your yearly deductible (if your plan has one) and any copayments or coinsurance you pay when you pick up your prescriptions at the pharmacy or get them by mail.

You may reach the $2,000 cap even if you personally haven’t paid that much. That’s because help from others—like government programs, charities or your drug plan—can also count toward the $2,000 limit. Your drug plan will keep track of what has been paid by you and others, and it will report on your progress toward the cap on your explanation of benefits.

My former employer told me I didn’t need to enroll in Medicare, and now I’m facing penalties. What can I do?
If on or after Jan. 1, 2023, you did not enroll in Part B during one of your Medicare enrollment periods because your employer or their representative gave you bad information, you may qualify for a Special Enrollment Period (SEP), which lets you sign up without paying a late enrollment penalty.

This often happens when someone is told COBRA, retiree insurance or a small-employer plan (fewer than 20 employees) is adequate coverage. However, Medicare doesn’t count these as primary, which means they don’t prevent penalties for late enrollment. To request the SEP, contact the Social Security Administration at 800-772-1213 and ask for the Medicare Part A and B SEP for Exceptional Circumstances application, which is also available online. You’ll need to provide proof that your employer gave you wrong information. You can mail or fax the completed application to your local SSA office.