One of the most significant changes coming to Medicare Part D in 2025 is the new $2,000 cap on outofpocket prescription drug costs. But what if the cap isn’t as simple as it sounds? In this video, we’ll break down how the $2,000 limit is really calculated and what it means for you.

0:00 0:39 Introduction
0:40 3:59 Important things to consider
4:00 5:20 2025 Prescription Drug Benefit Structure
5:21 8:22 Understanding the "TrOOP"
8:23 13:44 Real World Example Number 1
13:45 18:05 Real World Example Number 2
18:06 21:46 Real World Example Number 3
21:47 24:14 Real World Example Number 4
24:15 27:10 Important trends for 2025

We’ll cover critical topics such as:

What is included in the $2,000 cap? Learn which prescription costs count toward the cap, such as medications covered under your Part D or Medicare Advantage plan.

What costs do NOT count toward the cap? Discover why your plan’s premiums, certain overthecounter medications, and some prescriptions like Ozempic may not be included.

The importance of your plan’s formulary: Find out how the medications your plan covers can impact your outofpocket expenses, and how to use Medicare.gov’s plan finder tool to ensure your drugs are covered.

Differences between basic and enhanced Part D plans: Understand how basic plans calculate your True OutofPocket (TrOOP) costs vs. enhanced plans and why this matters when it comes to reaching the $2,000 cap.

Reallife examples: See practical examples using different plans and medications to understand how your costs may differ in 2025 and why some people will reach the cap faster than others.

Elimination of the “donut hole”: Finally, say goodbye to the coverage gap! Learn how this affects your prescription costs for 2025 and beyond.

Whether you’re on a standalone Part D plan or a Medicare Advantage plan, understanding this new cap is key to managing your drug costs. Don’t miss our examples, tips, and strategies to help you prepare for this critical change in Medicare.

Watch now to learn how to maximize your Medicare coverage for 2025! Also, don’t forget to check out our Part D analysis tutorial video for a stepbystep guide on using the Medicare.gov plan finder tool:    • How to Find the Right 2025 Part D Pla...  

Important Links & Sources:

Medicare Landscape Files (Basic vs. Enhanced): https://www.cms.gov/medicare/coverage...

CMS $2,000 Cap Technical Document: https://www.hhs.gov/guidance/sites/de...