Medicare Part D in 2025: A First Look at Prescription Drug Plan Availability, Premiums, and Cost Sharing

[Duaine]

Overall, KFF analysis shows that the market for Part D coverage remains robust based on the overall number of plan options, but the number of sponsors, plans, and enrollees in the stand-alone PDP market has trended downward over time, while the MA-PD market remains stable and continues to experience steady enrollment growth. In part, this reflects the predominance of low- or zero-premium MA-PDs and the availability of extra benefits, which are enabled by rebates in the Medicare Advantage payment system and amplified by aggressive marketing. Monthly premiums for stand-alone PDPs are substantially higher than for MA-PDs.

Medicare Part D Highlights for 2025

• The average Medicare beneficiary has a choice of 48 Medicare plans with Part D drug coverage in 2025, including 14 Medicare stand-alone prescription drug plans (7 fewer than in 2024) and 34 Medicare Advantage drug plans (2 fewer than in 2024). Over the past 10 years, the number of PDPs available to the average beneficiary has decreased by 52% while the number of MA-PDs has increased by 143%.
• The number of firms offering stand-alone PDPs has dropped from 11 in 2024 to 7 in 2025, along with a reduction in the overall number of PDPs (down from 709 to 464).
• In 2025, a smaller number of PDPs will be "benchmark" plans – that is, PDPs available for no monthly premium to Medicare Part D enrollees receiving the Low-Income Subsidy (LIS) – than in any year since Part D started. Medicare beneficiaries will have access to 1 less benchmark PDP in 2025 than in 2024, on average – two out of the average 14 PDPs available overall. An estimated 1.1 million LIS enrollees (26% of all LIS PDP enrollees) need to switch plans during the 2024 open enrollment period if they want to be enrolled in a benchmark plan in 2025.
• The estimated average enrollment-weighted monthly premium for Medicare Part D stand-alone PDPs is projected to be $45 in 2025, a modest increase from $42 in 2024 (based on June 2024 enrollment). After accounting for enrollment choices by new enrollees and plan changes by current enrollees, the actual average weighted PDP premium for 2025 is likely to be lower than the estimated average of $45.
• Monthly premiums for drug coverage are estimated to be six times higher for PDPs compared to MA-PDs in 2025 – $45 versus $7. The average monthly premium is projected to increase for PDPs but decrease for MA-PDs. MA-PD sponsors can use rebate dollars from Medicare payments to lower or eliminate their Part D premiums, as well as provide extra benefits, but there is no equivalent rebate system for PDPs.
• Average monthly premiums for the 12 national PDPs are projected to range from around $3 to $128 in 2025. Premium variation across plans is in part related to whether plans offer basic or enhanced benefits and the value of benefits offered, as well as variation in the underlying costs that plans incur for their enrollees.
• More than half of non-LIS Part D PDP enrollees (7.0 million out of 13.1 million) will see a reduction or no change in their monthly premium in 2025 if they make no changes during open enrollment, but 1 in 5 non-LIS PDP enrollees (2.6 million) will see their monthly premium increase by $35 if they stay in their same plan for 2025. This is the maximum increase allowed for PDPs participating in the new Part D premium demonstration, which includes measures intended to stabilize the PDP market as major changes to the Part D benefit take effect in 2025, including a new $2,000 out-of-pocket drug spending cap.
• The share of MA-PD enrollees who will be in plans that charge a deductible for Part D coverage will nearly triple from 21% in 2024 to 60% in 2025 if they do not switch plans. Most stand-alone PDP enrollees (84%) will also be enrolled in plans that charge a deductible for drug overage in 2025, similar to the share in 2024 (87%). (Some of the enrollees in these plans receive low-income subsidies that cover their deductible.) The average deductible in 2025 will be more than twice as large for PDP enrollees as for MA-PD enrollees ($486 versus $225) (the standard deductible in 2025 is $590).
• Many Part D enrollees will face coinsurance rather than copayments for both preferred brands and non-preferred drugs, which can mean less predictable out-of-pocket costs. This includes a larger share of MA-PD enrollees compared to 2024: 28% will be in plans that charge coinsurance for preferred brands versus 2% in 2024, and 57% will be in plans that charge coinsurance for non-preferred drugs versus 11% in 2024. Among PDP enrollees, 83% will be in plans that charge coinsurance for preferred brands and 100% in plans charging coinsurance for non-preferred drugs in 2025. For specialty tier drugs (those that cost more than $950 per month), median coinsurance will be 25% for PDP enrollees and 30% for MA-PD enrollees.
• [EXTERNAL LINK] - Medicare Part D in 2025: A First Look at Prescription Drug Plan Availability, Premiums, and Cost Sharing | KFF

 

[axeman462]

to bundle MAPD and stand alone PDP into the same basket is a lame attempt at inflating the numbers to make a bad situation look better.

Almost half the population will not consider an MAPD.
The other half will not ever consider a PDP.
It is a relatively small slice of the people that will actually consider crossing the line from MAPD to OM and vice versa.

So immediately, those numbers are cut in half at least.

looking at just PDP in Florida you only have 14 plans across 6 carriers. Of which 1 carrier with 2 plans, Florida Blue, is not really competitive. And there are another 6 plans offer by another 4 carriers that is not very competitive at all. And then another 2-3 plans that are moderately competitive in any given scenario.

What you are left with in the typical Rx scenario is, at best, 3-4 plans (but usually 1, maybe 2) plan options for the customer.

Its horrendous.

10 years ago we had something like 34 different plans offered by 9 or 10 different carriers. And often had 6 or 7 drug plans within a few dollars of each other in total cost. It was true competition.

 

[somarco]

Not to detract from your post, but averages are fine if you or your client are average.

Average means an equal number of results above the average and an equal number under the average.

Not everyone lives at Lake Wobegone where the women are strong, the men are all good looking and the children above average.

I hear agents say things like the MOOP is (pick a number) $2000 . . . $5000 . . . $10000 but no one ever hits that.

My book is relatively small but in 2024 I have half a dozen (that I know of) who had claims xs of $300k and one that has racked up almost $1M in claims.

I guess you could say they are above average . . . but not in the way you would like.

The ability to absorb an unexpected bill of $3k to $6k or more can be challenging for most folks "on a fixed income".

Some of my clients are having trouble wrapping their mind around paying $2,000 for very expensive meds even though the premium is $0.

And some only recently discovered their SilverScript premium jumped from $15 to $50 because they failed to read the ANOC and my newsletters warning them about the premium increase as well as the 12/7 deadline.

 

[LostDollar]

The ability to absorb an unexpected bill of $3k to $6k or more can be challenging for most folks "on a fixed income".

I tried pulling that line on @rousemark once. He just popped right back with "it all depends on where your income is fixed", or something similar.

 

[rousemark]

I tried pulling that line on @rousemark once. He just popped right back with "it all depends on where your income is fixed", or something similar.

A lot of retiree's fixed income is higher than the income of those still working. However, I have never understood that phrase. If you are working on a salary basis, your income is fixed. I used to tell people that tried to give me that so story, "I wish my income was fixed. It is possible I won't make anything today."