Medicare Drug Coverage Selection Now More Difficult – 910News.com
TL/DR –
The number of Medicare Part D plans, which provide prescription drug coverage, has fallen 22% from 2025 to just 360 plans nationwide, a 50% reduction from 2024 figures. The Inflation Reduction Act introduced a $2,000 out-of-pocket cap, which increased cost and risk for drug plans while lowering their profitability, leading many to exit the market. With a significant rise in out-of-pocket costs among some plans, Rich Daly of the Healthcare Financial Management Association suggests Medicare Part D enrollees should shop around to ensure their necessary drugs are included in the drug formulary and to understand out-of-pocket cost variations such as deductibles or co-payments.
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Decreased Number of Medicare Part D Plans May Prompt Extra Research During Open Enrollment
Individuals enrolled in Medicare seeking prescription drug coverage in the coming year may need to dedicate additional time to research during the open enrollment period.
A Sharp Reduction in Medicare Part D Plans
The number of Medicare Part D plans, which provide prescription drug coverage to traditional Medicare members, saw a sharp reduction of 22% to 360 plans countrywide compared to 2025 figures. This decline amounts to a 50% reduction from 2024.
Impact of the Inflation Reduction Act on Medicare Part D Plans
The introduction of a $2,000 out-of-pocket cap by the Inflation Reduction Act increased the cost and risk for these drug plans, as stated by Rich Daly, senior editor for the Healthcare Financial Management Association. This legislation also transferred a greater share of high drug cost responsibilities to these plans. As Daly explained, the profitability of these plans was adversely affected, leading to an exodus of several plans from the market.
Regional Limitations and the Importance of Shopping Around
Given that Part D plans are offered regionally, most enrollees will only have between 8-10 plans to choose from. This choice is further limited by the fact that the number of companies offering these plans ranges from four to six in each state, even if there are eight plans available in a particular area. Hence, it is crucial for Medicare Part D members to explore their options, said Daly.
Considerations for Enrollees When Choosing a Plan
Daly further emphasized the importance of ensuring that the required drugs are included in the drug formulary. Additionally, enrollees must consider the variations in out-of-pocket costs, such as deductibles or copays. With a significant increase in out-of-pocket costs among some plans as a tactic to increase profitability, these variables become critical considerations, Daly noted.
Changes in Deductibles and Co-Payments
In 2025, several drug plans shifted away from offering zero deductibles and co-payments for preferred drugs, shifting towards higher co-insurance. As a result, Daly expects that the monthly premiums paid by standalone plan enrollees in 2026 will experience a significant increase.
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