Living with ALS presents a unique set of challenges, especially when it comes to managing your health care needs and medications. In 2025, important changes are coming to Medicare that could significantly impact how you access prescription drugs and manage your out-of-pocket costs.
A new Medicare prescription drug benefit and drug savings are coming in 2025 for Medicare Part D enrollees. Everyone living with ALS on Medicare should review their drug plans this fall, even if satisfied with their current one, and consider these new programs.”
These changes aim to make prescription drug costs more predictable and affordable, but understanding all of your options is critical to making the decisions that are right for YOU.
This blog will help walk you through the key updates and changes coming, including Medicare Open Enrollment and the new Medicare Prescription Payment Plan (MPPP), so that you can make the most informed decisions for your health.
Medicare Open Enrollment for 2025: Key Dates and What to Know
The Medicare Open Enrollment period runs from October 15 through December 7, 2024. During this time, you can review and change your Medicare plan to ensure it meets your needs for the coming year. As you prepare for the 2025 plan year, it’s important to pay close attention to how these changes may affect your coverage.
If you’re satisfied with your current plan, you don’t need to take any action, but it’s always wise to compare options since your health needs and Medicare plans can change. Start by visiting the updated Medicare Plan Finder on Medicare.gov, which now includes 2025 plan information. The tool allows you to compare costs, coverage, and plan quality, giving you a clearer picture of your options.
If you need help navigating this process, you can contact your State Health Insurance Assistance Program (SHIP) for free, personalized counseling. SHIP counselors can assist you in understanding your options, comparing plans, and answering any questions about Medicare.
What’s New in 2025?
Significant changes are coming to Medicare in 2025, particularly concerning Medicare Part D. Here are some of the most critical updates:
1. Out-of-Pocket Cost Cap for Prescription Drugs
One of the most significant changes is the introduction of a $2,000 annual cap on out-of-pocket prescription drug costs. Once you reach this cap, you won’t have to pay anything for covered prescription drugs for the rest of the year. This is a welcome change for people living with ALS, who often face high prescription costs due to the nature of their treatments.
2. Medicare Prescription Payment Plan (MPPP)
In 2025, Medicare will introduce the Medicare Prescription Payment Plan (MPPP), designed to help spread the cost of prescriptions over the year. If your prescription drug costs are high, the MPPP allows you to pay for your medications in zero-interest monthly installments, rather than covering the full cost at the time of purchase. This feature can provide much-needed financial relief for people managing expensive treatments.
You can opt into the MPPP during the Medicare Open Enrollment period or anytime during the year. It’s important to note that participation is voluntary, and you must actively enroll by contacting your Part D plan. Your pharmacy cannot sign you up for this program, but they may inform you if a single prescription exceeds $600, which could make you eligible for the MPPP.
Once enrolled, your Part D plan will send you monthly bills for your prescriptions, allowing you to spread out the costs over the year. However, keep in mind that this will not cover your Medicare Part D premium, which you still need to pay monthly.
Is the MPPP Right for You?
Deciding whether to enroll in the MPPP will depend on your financial situation and prescription needs.
The MPPP can be a good option if:
- You anticipate high out-of-pocket prescription drug costs.
- You prefer to spread payments out over the year to make budgeting easier.
- You want to avoid large, one-time payments when picking up prescriptions.
However, the MPPP may not be necessary if:
If you’re unsure whether the MPPP is the right fit for you, consult with your Medicare Part D plan or a SHIP counselor. They can help you understand how the program will impact your monthly expenses and whether it’s the best option based on your needs.
- Your monthly prescription drug costs are low or manageable.
- You qualify for Extra Help, a program that provides additional financial assistance for those with limited income and resources. Extra Help beneficiaries will see maximum drug costs of $12.15 for brand-name drugs and $4.90 for generics.
Extra Help and Other Support Programs
If you qualify for Extra Help, it may provide greater financial benefits than the MPPP. Starting in 2025, people who qualify for Extra Help will pay significantly reduced copays for prescription drugs, and for some individuals, it may eliminate most out-of-pocket costs altogether.
To qualify for Extra Help, your income must be at or below 150% of the federal poverty level (FPL), which translates to $22,590 for individuals or $30,660 for married couples. Your resources must also fall below $17,220 for individuals or $34,360 for couples.
If you rely on state assistance programs, such as the State Pharmaceutical Assistance Programs (SPAPs) or AIDS Drug Assistance Programs (ADAPs), it’s crucial to contact those programs to see if enrolling in the MPPP will affect your benefits.
How to Enroll in Medicare Part D and MPPP
If you’re not already enrolled in a Medicare Part D plan, you’ll need to sign up for one during the Open Enrollment period before you can take advantage of the MPPP. The steps are as follows:
- Visit Medicare.gov or call 1-800-MEDICARE to compare Part D plans and choose the one that best suits your needs.
- Contact your Part D plan to opt into the MPPP. You can do this online, over the phone, or by mail. Be sure to sign up early, as waiting until you have a high-cost prescription could limit your ability to spread out the costs effectively.
Stay Informed and Get Help
Staying up to date with your Medicare options is crucial, especially with the new changes coming in 2025. Our ALS care teams and ALS certified centers and clinics are great resources because they work with people with ALS and their insurers on a regular basis, so they have a great understanding of how to manage the process and how to deal with the challenges that arise, because there will likely be challenges.
Here are some of the many ways you can stay informed:
- Visit Medicare.gov to review your plan options and learn more about the new prescription drug law.
- Contact your local ALS care team or ALS certified center/clinic with any questions you may have.
- Contact your local SHIP for personalized advice and support.
- Speak to your health care provider and pharmacy about how the new rules might affect your personal medication costs.
- For more complex financial or insurance issues, we’ve partnered with the Patient Advocate Foundation (PAF) to provide The ALS Insurance and Benefits Resource Line, a FREE resource designed to provide individualized case management assistance for people living with ALS, their family members and caregivers.
Reducing the financial harms of ALS is a key component to making ALS a livable disease until we find a cure. By understanding your options and making informed decisions during this year’s Medicare Open Enrollment period, you can better manage your health care needs more effectively, and we’re here to help you every step of the way.
You can access The ALS Insurance and Benefits Resource Line by calling 1-844-244-1306, or complete a request for help form HERE.
https://www.als.org/blog/navigating-medicare-changes-2025-people-living-als-comprehensive-guide
