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The Inflation Reduction Act of 2022 (IRA) made important changes to the Medicare Part D program that have the potential to impact creditability of coverage calculations for employers in 2025. Specifically, the out-of-pocket maximum (OOPM) limit was reduced from $8,000 in 2024 to $2,000 in 2025.
The Part D late enrollment penalty is calculated by multiplying 1% times the national base beneficiary premium ($36.78 in 2025) times the number of full, uncovered months you were eligible to join Medicare drug coverage but didnt (and didnt have other creditable prescription drug coverage).
Dont go 63 days or more without a drug planIf you had and lost drug coverage from a creditable provider (current or former employer, TRICARE, individual health insurance coverage, etc.) you must join a new Medicare Part D drug plan in fewer than 63 days.
A person will usually receive a Notice of Creditable Coverage in the mail every September, and they should keep this as proof should they later apply for Medicare coverage. If a person wishes to enroll in Medicare after their creditable coverage ends, they may be eligible for the Special Enrollment Period.
Yes, the Medicare Part D coverage gap, often referred to as the donut hole, ended in 2025, leaving 3 simple phases of coverage: Deductible Phase: Beneficiaries will pay 100% of their drug costs until they meet their deductible.
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In 2025, your yearly out-of-pocket drug costs will be capped at $2,000. If you have Medicare drug coverage (Part D) and your drug costs are high enough to reach this cap, you dont have to pay a copayment or coinsurance for Part D drugs for the rest of the calendar year.

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