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Overview of Medicare changes

The Inflation Reduction Act (IRA) introduced several changes to Medicare Part D, aimed at reducing healthcare costs for older adults on Medicare.

Starting in 2025, changes included:

  • Elimination of the coverage gap, commonly referred to as the “donut hole.”
  • A newly defined standard Part D benefit design consisting of three phases: annual deductible, initial coverage and catastrophic coverage.
  • Lower maximum out-of-pocket costs (MOOP): Medicare Part D beneficiaries will have out-of-pocket spending for prescription drugs capped at $2,100 annually. This will change to $2,100 in 2026.
2026 Coverage phases

Beneficiaries will have 3 phases of coverage (reduced from 4 phases in prior years) with a maximum out-of-pocket spending limit of $2,100.

  • Phase 1: Annual Deductible

    Deductible up to $615 (if applicable to selected plan)

  • Phase 2: Initial Coverage

    25% co-insurance until reaching $2,100 (including deductible)

  • lockedPhase 3: Catastrophic Coverage

    No cost sharing for covered drugs

What counts toward the $2,100 maximum OOP spending limit:

Yearly deductible

Coinsurance

Copayments

What doesn't count toward the $2,100 maximum OOP spending limit:

Medicare Part D prescription drug plan premium

Pharmacy dispensing fee

What you pay for prescription drugs that aren’t covered

Better understand Medicare plan changes
It’s important to review your Medicare plan each year during Open Enrollment Period (OEP). Your Medicare plan will send an Annual Notice of Changes (ANOC) letter in September, which outlines changes that begin in January:
Coverage

Look for coverage additions and removals. Make sure services and medications you need are still covered, and review updated coverage terms.

  • Consider: Have my health needs changed, and is my coverage sufficient?
Cost (premiums, deductibles, copays)

Information will be included about the new new out-of-pocket maximum, which may affect your overall expenses.

  • Consider: Are my premiums changing or staying the same?
Drug formulary (covered drug list)

Make sure your medications are still covered, and check if they’ve moved to a different tier, which could affect the cost.

  • Consider: Are my medications still on the plan’s covered drug list? How has the drug formulary changed?
Provider and pharmacy network

Make sure your providers and hospitals are still in-network, and any specialists you see regularly are still covered. Preferred Network Pharmacies may help you save on money with low-cost copays.

  • Consider: Is my pharmacy in the plan’s network?
Need more information about Medicare?

Visit the official US government website for Medicare: Medicare.gov

Speak with a licensed HealthCompare insurance agent
Call: 1-800-550-8819 (TTY users 711)
Monday through Friday 8 a.m. to 9 p.m. EST

References

1. https://www.cms.gov/newsroom/fact-sheets/draft-cy-2025-part-d-redesign-program-instructions-fact-sheet

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