Get Informed: Important Changes to Medicare Part D

Learn about the upcoming changes to Medicare Part D, and what you need to do.

Medicare Part D is the part of Medicare health insurance that covers prescription drugs. You can have a separate Part D plan, or your Part D plan may be part of your Medicare Advantage plan.

Starting in 2025, Part D will see two key changes:  

  • A new $2,000 annual out-of-pocket cap on prescription drug costs.  
  • A new payment plan option to help people spread out payment for their drugs over the entire year. This is called the Medicare Prescription Payment Plan. *You must proactively opt in to this - see below for more information.*

These changes will apply to all Medicare Part D drug plans and all Medicare Advantage plans with drug coverage. Medicare open enrollment runs from October 15th through December 7th.

The following resources will help you understand the upcoming changes, and what you need to do:

Frequently Asked Questions

The out-of-pocket maximum is $2,000 in 2025. After reaching this limit, you will pay $0 for Part D prescription drugs for the rest of the year. 

The Medicare Prescription Payment Plan, or MPPP, is a new program offered by Medicare for prescription drugs. The MPPP will let you spread out your prescription drug out-of-pocket costs on a monthly basis for the rest of the year, without interest, instead of making a big single payment when you fill a prescription at the pharmacy. 

The MPPP will spread out your costs over the calendar year, which may help you budget your costs and make your medicines more affordable. Instead of paying the total cost of your prescriptions at the pharmacy, the MPPP will let you spread those costs over the course of the year and pay in monthly installments. The MPPP ends on December 31 of each year, which means that you must re-enroll into the program each year if you want to continue to participate. 

Once you opt into the MPPP, you will get a monthly statement from your Part D plan. You will not have to pay for your medications at the pharmacy or other places you may fill your prescriptions that are covered by Medicare. You can pick up your prescription drugs at the pharmacy, and you will later get an updated statement from your Part D plan. Your statement will have information on the amount due to the plan and your current remaining balance for the rest of the year. This monthly statement is separate from your Explanation of Benefits or your Part D plan premium notice, which you may also get from your Part D plan. 

Anyone with a Part D plan can participate in the MPPP. However, if you qualify for Extra Help, then Extra Help will benefit you more than participating in the MPPP. 

Participation is voluntary and not automatic. You must enroll through your Part D or Medicare Advantage plan. 

You must enroll in the MPPP through your Part D or Medicare Advantage plan. Your plan will give you a phone number, website, or mail option to enroll in the MPPP. You may see a form called the “Medicare Prescription Payment Plan Participation Request Form.” Make sure to click or check the “opt in now” or “I agree” if you decide to enroll. 

You can enroll during open enrollment or any time during the calendar year before December. Since payments are spread out over the remaining months in the year, you will see the most benefit by enrolling earlier the year. 

After you opt into in the MPPP (and stay enrolled), your costs for all Part D prescription drugs in the calendar year will be included in the monthly billing statements shared by your Part D plan. You do not need to opt in more than once in a calendar year. 

No, all payments made under the MPPP are interest-free, and there are no fees to participate. And while your costs are spread out over monthly payments, your total prescription drug costs for the year will be the same whether you participate in the MPPP or not. Also, you never will pay more than the out-of-pocket cap, which is $2,000 in 2025. 

If you opt into the MPPP during 2025 and would like to do so again in 2026, you may need to re-enroll, even if you re-enroll in the same Part D plan. Contact your plan and look at your options during the 2026 open enrollment period. 

Once you enroll in MPPP, all payments are billed from your Part D plan monthly. You will not have to pay at the pharmacy. You can pay by check, credit or debit card, etc. Check with your plan to know what options are available to you. 

Once a payment is missed, you have 2 months to pay the balance. Your Part D plan will send you a notice with the date by which the unpaid balance must be paid to stay in the MPPP. As long as you pay the overdue balance before the 2-month deadline, you can still stay in the MPPP. 

Your plan must send you a notice of termination. The statement will include instructions on how you can ask for more information and how you may qualify to re-enroll in the MPPP. Your plan can add you back to the MPPP if you pay your balance or if you show that there was a good reason for the unpaid balance. 

However, if you are disenrolled, your plan may stop you from enrolling in the MPPP next year if there is an unpaid balance. But your plan cannot remove you from the plan unless you miss your monthly premium payments. 

LLS’s copay assistance program awards amounts based on total overall need, whether or not you choose to opt into the MPPP. Remember, all covered prescription drug costs for Medicare Part D are capped at $2,000 whether or not you choose to enroll in the MPPP, so your copay award amount will not change.  However, if you do enroll in the MPPP, you won’t pay your copayment at the time you receive your medication. You will need to submit your monthly MPPP statement through the copay program. 

Additional Resources