Crucial Updates and Changes to Medicare 2025

Today, we are honored to have Leigh Purvis with AARP joining us today. She is the principal on prescription drug policy at AARP's Public Policy Institute, and she is instrumental in leading efforts to improve prescription drug affordability and accessibility for older adults. In this episode, we get into some critical updates and changes to Medicare with Leigh, hitting on key topics such as open enrollment dates, the introduction of new out-of-pocket spending caps, new monthly caps on insulin copays, and new vaccine benefits. Leigh also sheds light on the importance of reviewing and understanding plan options to ensure better healthcare coverage and costs for Medicare beneficiaries. Get ready for an episode packed with valuable insights and practical advice that you won't want to miss!

Website: AARP Medicare Resources

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Transcript

Darleen Mahoney [00:00:01]:

And today we have Leigh Purvis joining us. She is the prescription drug policy principal in AARP's public policy institute, where she heads this institute on Prescription drug issues and is a recognized expert on prescription drug pricing and coverage. Her work focuses on improving prescription drug affordability, which we all love, and accessibility for older adults. She's testified before Congress, which I think is super cool, and state legislators on behalf of AARP, and speaks frequently on a wide variety of prescription drug related issues. She is also the co author of the AARP's PPIRx, which stands for Prescription Price Watch reports, which have been tracking the prices of prescription drugs widely used by older American CISDA 2004. Thank you for joining us today on.

Leigh Purvis [00:00:57]:

Our podcast, Lee, thank you so much for having me.

Darleen Mahoney [00:01:00]:

Yeah, absolutely. And we're all, your whole background is very prescription related. We're going to talk about a little bit of a different subject, something that's really, really important, and we just don't want our seniors to miss it because, you know, information is key, knowledge is power, as they say. So we're going to talk more about the changes to Medicare.

Leigh Purvis [00:01:22]:

Sounds like a plan.

Darleen Mahoney [00:01:24]:

Perfect. Perfect. So tell us a little bit. First of all, when is open enrollment? I think that that's a great place.

Leigh Purvis [00:01:32]:

To jump off, and that is a great question. So it's not necessarily something that everyone is aware of, but every year Medicare has an open enrollment season that runs from October 15 until December 7. And that gives people in Medicare the opportunity to review their plan options and decide whether it's, whatever plans are in are still the best option for them.

Darleen Mahoney [00:01:53]:

Yeah. And I love it because we're going to get this information out right during open enrollment. So hopefully people will get the info as they're making those very, very vital decisions, because once they've made that decision, they're locked into that. Correct. Till the next open enrollment season.

Leigh Purvis [00:02:09]:

They are. There are a few exceptions where people may be able to switch their plan during the plan year, but generally speaking, yes, this is the time of year for people to really get in there and review their options and time to make a decision.

Darleen Mahoney [00:02:20]:

Yeah. I know that for my dad, I did have to make an adjustment during that timeframe, but it was something that was, I think, very specific to his location. He had moved from one location that only provided him those extended benefits within his area. But I moved him over here once he was diagnosed with dementia, and we had to change those locations so that he could get, he could get care in this area. So.

Leigh Purvis [00:02:46]:

Yeah. Yeah, that's exactly right. Yep.

Darleen Mahoney [00:02:48]:

Yeah. Perfect. So tell us a little bit about the benefits in Medicare, and then let's jump into some of the changes as well, because they're big ones this year, right?

Leigh Purvis [00:03:00]:

There are some really big changes coming. There is a law that passed in 2022 that is in the process of being implemented, and it has created a lot of new benefits for people in Medicare. Starting next year, Medicare prescription drug plans are going to be more generous than ever, including a new $2,000 out of pocket spending cap. There are also going to be some additional changes, like a $35 cap on monthly co pays for insulin. You can get recommended vaccines for free, and there's also a new program that's going to allow you to spread your out of pocket costs over the year. So this new law and its implementation has been coming for the past couple years and is really going to have a big impact starting next year.

Darleen Mahoney [00:03:39]:

Wow, I love that there's a cap on prescriptions because prescriptions are stupid expensive.

Leigh Purvis [00:03:45]:

That is absolutely right.

Darleen Mahoney [00:03:46]:

They 100% can be. And as you age, your prescription list tends to increase a little bit.

Leigh Purvis [00:03:54]:

It does, actually. On average, people in the Medicare program are taking between four and five prescription drugs per month. And what used to happen for people who were on those expensive drugs is there wasn't an out of pocket cap. And so we had some people on expensive drugs who were spending upwards of $10,000 per year just on those prescription drugs. So the fact that there's now this new $2,000 out of pocket cap is a huge improvement.

Darleen Mahoney [00:04:15]:

Yeah. I don't know how people on a fixed income can swing $10,000 a year. That's a lot.

Leigh Purvis [00:04:22]:

And that's actually the point that ARP makes when we're talking about this issue, is the idea of spending $10,000 is virtually impossible when you're talking about someone who's on a fixed income, but it's really impossible for anyone.

Darleen Mahoney [00:04:32]:

Yeah. Oh, 100%. 100%. And those drugs are typically things that they need, I would imagine. And I feel like some of those folks, if they can't afford that, if that $10,000 cap or what have you, was just too overwhelming and it wasn't something in their budgets. They weren't taking and getting that medication, so they were actually missing out, that's.

Leigh Purvis [00:04:54]:

Exactly what was happening. We heard about far too many people that were having to make those tough decisions, and sometimes they were having to choose between their prescription drugs and other important things like their food or their rent. And other ones were just choosing not to take their prescription drugs at all or not taking those prescribed. And I think we all know that that can lead to much bigger health problems down the road. So not a situation when we want anyone to be in.

Darleen Mahoney [00:05:14]:

No 100%. So tell me a little bit about this copay for that's a cap on the insulin. So what's the difference between, because I am completely unfamiliar with that. So I completely have no clue what that means.

Leigh Purvis [00:05:31]:

So prior to this new law, what we had to were some people in these Medicare prescription drug plans spending a lot of money on their insulin. And so what the law did was say you will not have to pay more than $35 per month for your insulin prescriptions. And that can lead to some pretty significant savings for people who are paying maybe $100 before. Now they're not going to have to spend that money. And that, of course, makes insulin more affordable. And that's a really important drug for the people who need it. So that new copay cap is going to make a really big difference.

Darleen Mahoney [00:06:03]:

That's a life saving drug.

Leigh Purvis [00:06:05]:

It absolutely is.

Darleen Mahoney [00:06:06]:

No one should be going 100%. It's definitely a life saving drug. And you mentioned, so are there, there's so many vaccines that are now coming out. That's another thing that I think is really interesting, specifically as I am aging. The recommendation for vaccines back in the day when I was younger, it would be, oh, just get your flu vaccine and then just the typical ones, you know what I mean? But now there's vaccines that are specifically for people that are aging, so they've added on different types of vaccines. So tell me a little bit about that.

Leigh Purvis [00:06:41]:

Yeah, I think the best example that most people are going to be aware of is the shingles vaccine. Yeah, that can be a really painful condition for people who develop shingles. And previously shingles was covered in a way that could result in some really high cost sharing. So now people can get that vaccine for free, which hopefully will help encourage more people to get it, because again, I don't think anybody wants to get shingles. And this vaccine can really be helpful in preventing that from happening.

Darleen Mahoney [00:07:05]:

Yeah. So I love to hear that and kind of understand that those things are going to be helpful as well in Medicare. One of the questions I wanted to ask you that you mentioned and I thought was really interesting, so I'm really excited to get some details on spreading out your payments throughout the year.

Leigh Purvis [00:07:23]:

Yeah, this is a really interesting change because we haven't really seen this anywhere in the healthcare system before, but it's really important for people who are on fixed incomes, people who are often in Medicare who are on a fixed income because the benefit that covers prescription drugs, known as Medicare Part D, is structured in a way where sometimes you can have really, really high cost sharing in one month and relatively low cost sharing and another if you're particularly if you're taking those expensive drugs. And what this allows you to do is spread out those out of pocket costs. So rather than, for example, being asked to pay the full $2,000, hit that out of pocket cap in January, you could make $167 monthly payments instead. And so that really will help people budget, especially when they're facing those high out of pocket costs and hopefully make it easier for them to afford their drugs.

Darleen Mahoney [00:08:11]:

Yeah, absolutely. I think that that's great. So as far as all these great benefits. Right. So in my mind, I'm thinking, okay, so you have all these great benefits. So is that going to just cost me more? Because you just think there's no way, there's, you know, no such thing as a free lunch.

Leigh Purvis [00:08:28]:

So, but is there in this instance, when you look at the law and how many different moving parts are in there, and we've really only scratched the surface on the different changes that are taking place overall and over time, this is going to result in billions of dollars in savings. And the expectation is that premiums and out of pocket costs will go down. That said, the market is what it is. And so there is certainly a chance that if you are in a Medicare health or drug plan, you could see higher premiums next year. And our solution to that is the same thing that we say every year during Medicare open enrollment, which is get out there and shop. People often have access to dozens of plans in their area. And so it really is a great time of year to get out there and compare those plans. And there's a very good chance you could find one with a lower premium or better coverage that is a better fit for you.

Leigh Purvis [00:09:19]:

So that's our general recommendation to everyone and why we so strongly encourage everyone to go out there and shop for their plan.

Darleen Mahoney [00:09:25]:

Yeah. So when they're shopping for a plan, what are some of the things that they should be looking at? Some key things that might differ between different offerings, I guess, is how I'm.

Leigh Purvis [00:09:38]:

So the first thing I think everyone pays attention to is, of course, the cost. So what is your monthly premium? What are you going to pay in cost sharing for the things you're going to be using for their, whether it's a prescription drug or your doctor's visit, you want to make sure that that cost sharing is affordable to you because some plans will charge a flat copayment and other plans will charge something known as coinsurance, which is where you're paying a percentage of the cost. And so that could be something someone wants to avoid. Also, deductibles can be different. So the costs are definitely one thing to look out. But the other part that is frankly equally important is the coverage. Does it cover the prescription drugs that you're taking? If you're looking at a health plan, does it cover the doctors that you're going to see? Does it cover the hospitals that are in your area? So it's really important to make sure that the plan covers the services and the prescription drugs that you're going to be using. And then the other thing to keep in mind is the convenience.

Leigh Purvis [00:10:28]:

You know, are your pharmacies and network. You have to drive a long way to get to see a physician, things like that. So there are a few different factors you want to take into consideration.

Darleen Mahoney [00:10:36]:

Yeah, that's quite a few different factors.

Leigh Purvis [00:10:39]:

It is, it is not an easy decision, but it is definitely worth the time to look into it because you want to make sure, one, that your plan is covering whatever services you need it to cover and then is also covering them in a way that's affordable to you.

Darleen Mahoney [00:10:52]:

Yeah. So I feel like you almost need like a checklist of all the things so you can go through them one by one. And when you're looking at those plans, is it fairly easy to read and understand, or is it something that's complicated for some folks that they might need some help on that end?

Leigh Purvis [00:11:09]:

There are, I guess, varying degrees of willingness to really dig into plans. And so we recognize that completely. There are some people who can go to Medicare dot gov and go to the Medicare plan finder and sort through all of their options with absolutely no concerns whatsoever. For people who do want a little bit of extra help, every state has something known as a state health insurance assistance program, and they are completely unbiased sources of information that can actually provide individualized assistance for your particular concerns and help you sort through your plan options and again, make that best decision for you.

Darleen Mahoney [00:11:41]:

Yeah, that's a good idea. It's nice to have that extra resource because I know especially people that maybe experiencing some cognitive impairment and things like that where they're starting to struggle a little bit with some of those things. I think it's good to have some extra because that can be very, very overwhelming to just, I know even when I took over my dad, I mean, I was overwhelmed myself just reading all this stuff. I'm like going, this is like what I think what they used to call reading, like stereo instructions. It can be something very difficult to kind of understand all the moving pieces. So to have that extra layer of support I think is really important as well. So. Yeah, no, I appreciate that.

Darleen Mahoney [00:12:21]:

So what is AARP? What do they recommend as far as providing resources from your end?

Leigh Purvis [00:12:30]:

So AARP is very well aware of the fact that Medicare can be incredibly complicated. And so we pulled together a lot of different resources that are available on our website@aarp.org, medicare. And we even have an enrollment guide on that site as well. If you're trying to make decisions about when, where and how to, to enroll in the Medicare program, what aspects of the Medicare program you want to enroll in, it is admittedly a very complicated program. And so we've done our best to make sure that we are able to answer and educate our members as much as we can.

Darleen Mahoney [00:13:01]:

Yeah, no, I appreciate that. And we're going to actually include that link in the content or description of the podcast, which anyone that's listening, if you're listening to it on Spotify, Apple, wherever you're listening to it, that link will be in there and it will be a hot link. So you can just click right on it and we'll take you right over to those resources on Aarpenna. So we've talked a lot. A lot of the changes seems to be very much prescription drug based. Are there other changes that are coming to Medicare?

Leigh Purvis [00:13:28]:

Most of the changes that we have been focusing on for this open enrollment have definitely been prescription drug related because that is primarily what was in that law that is being implemented right now. That said, Medicare health and drug plans change every year. And so there is certainly a chance that if you are already enrolled in a plan, it is a very good time for you to take a look at what that plan is doing for the coming year because you can see a lot of changes in terms of what they cover and how they cover it and how much you have to pay for it. So that kind of goes back to our overarching message of take a look at your plans and make sure you're still on the best one for you.

Darleen Mahoney [00:14:03]:

Yeah, that's a good point, because I know even I'm not on Medicare, but I do know that my plan changes every time, and sometimes you don't really catch it and then all of a sudden your, you know, in office visit is $20 more than it was last time. And you're like, wait a minute. I didn't know this part changed, but you also increased my rates, you know, my monthly cost. I'm like, well, wait a minute, hold on. So I know that that's a really good idea to just go in and see what you currently have, because what you had this past year even may not be the same thing that you get next year on your core. I want to call them products or services or whatever your choices that you make based on what they offer.

Leigh Purvis [00:14:44]:

Yeah, and that's exactly right. And it's even more so important this year because we know that plans are changing in response to this law and the new generosity of the coverage that they're all required to provide now, which goes back to just the importance of open enrollment and the importance of really taking a hard look at your plan and then what other plans might be available.

Darleen Mahoney [00:15:04]:

Yeah, no, these are all excellent tips. I'm really hoping that we have our listeners that really dig into what they're, they're doing because they really want to be able to protect themselves and get what they need, and it's not a choice they should really make lightly. So. Yeah.

Leigh Purvis [00:15:19]:

And as you mentioned, this is the only time of year, really, to be able to dig into this and make those decisions. So we certainly don't want anyone getting to January 1 and realizing that their.

Darleen Mahoney [00:15:28]:

Plan no longer works for them 100% now. That's perfect. Well, before we sign off, is there anything else that you wanted to mention that we haven't talked about with Medicare in general or changes?

Leigh Purvis [00:15:40]:

You know, honestly, I just want to keep hammering on that overarching message of please, please, please look at your plan options this year. Medicare, health and drug plans are changing. There's a lot of change in the larger environment from this new law that is providing these important, really generous new benefits. But we want to make sure that everyone's in the right plan for them. So to the extent you can, please take a look at your plan options and make sure in the best one for you.

Darleen Mahoney [00:16:03]:

Yeah, absolutely. And you know what? I really just want to add, I really appreciate the work that AARP does to be advocates for seniors when they're not able to advocate for themselves and to provide those resources for our listeners and seniors and caregivers to access that information. And there is so much on the AARP website, it's literally mind blowing those resources that you can tap into. So I do appreciate all the work that AARP does and the advocating that you do on their behalf, even as much as mentioning you're going up and talking before Congress. I mean, you're really taking it to that next level to get some of these things passed. I really do appreciate, and I know our listeners do, too.

Leigh Purvis [00:16:46]:

Thank you for saying that. Yeah, it is our pleasure to do this work on behalf of our members.

Darleen Mahoney [00:16:49]:

Yeah, absolutely. Well, thank you so much for joining us on this podcast. And we appreciate you joining us today as well, Lee. And if you enjoyed this podcast, please listen to some of our other podcasts. We have a variety of different topics. We have a little less than 90, I think, at this point, so lots to choose from. We are available on Spotify, Apple Podcasts, good pods, pretty much anywhere you