Changes to Medicare Drug Coverage You'll See in 2025

Key takeaways

• Benefit from the $2,000 out-of-pocket cap for prescriptions in 2025, per Tricia Sandiego.
• Experience predictable medication costs as the “donut hole” coverage gap is eliminated for good.
• Access popular drugs like Ozempic more easily, with eased restrictions under Medicare’s new updates.

Summary

Major changes to Medicare prescription drug coverage in 2025 could save you thousands of dollars and make your medications more affordable than ever. Medicare advisor Tricia Sandiego highlights the biggest updates, including a new annual out-of-pocket cap — meaning you’ll pay no more than $2,000 each year for covered prescriptions. The notorious “donut hole" coverage gap will be eliminated, so your costs will be more predictable and manageable.

Another important Medicare drug coverage update: Restrictions are easing for certain medications, making it possible that popular drugs like Ozempic, when prescribed for conditions such as diabetes, may now be covered. These enhancements are designed to improve access, keep costs down, and help you get the care you need. For more resources and up-to-date information, visit aarp.org/medicare.

The key takeaways and summary were created with the assistance of generative AI. An AARP editor reviewed and refined the content for accuracy and clarity.

Full Transcript:

[00:00:00] Medicare is rolling out some positive changes in 2025 that may make a big

difference in your life and save you thousands.

[00:00:09] Hi, I’m Tricia Sandiego, and I work with AARP to help navigate the ins and outs

of Medicare.

[00:00:15] Let’s take a look at some of the changes to Medicare drug coverage in 2025. OK,

let’s dig in.

[00:00:23] In 2025, for the first time ever, Medicare recipients will have an annual cap on

prescription drug costs.

[00:00:31] That means they will not spend more than $2,000 out of pocket in a year.

[00:00:37] This groundbreaking move will help roughly 3.2 million Americans in 2025.

[00:00:43] Before this change, some people were paying that much in 1 month alone for

their medications.

[00:00:49] The prescription drug coverage gap known as the dreaded donut hole — their

term, not mine — is officially gone.

[00:00:57] In the past, if you’d reached the limit of your plan’s prescription drug coverage,

deductibles, copays, and coinsurance, you were responsible

[00:01:05] for 25% of your plan’s cost for every covered prescription drug until you

[00:01:10] reached your out-of-pocket limit. That’s the donut hole. Now, you’ll only need to

meet a deductible before predictable

[00:01:18] copayments kick in, and those will apply until you reach that $2,000 cap.

[00:01:25] Another change is the easing of restrictions around weight loss drugs. Medicare

has historically shied away from covering these kinds

[00:01:32] of drugs, but that’s changing. In 2025, you may find that popular medications like

Ozempic could be covered

[00:01:41] if prescribed for conditions like diabetes, making treatment more accessible.

These are just a few changes for 2025.

[00:01:49] And for more detailed and up-to-date information about eligibility and coverage,

visit aarp.org/medicare and subscribe to our YouTube

[00:01:59] channel to stay informed on the latest health care updates from AARP.