Union Risk Advisors hosted a panel discussion with Regan Debban, Principal at Benefit Comply and Matt Miklos, Individual Medicare Solutions Leader at UROne Benefits™ on September 18. 

Watch the full webinar here to learn more about the upcoming changes to Medicare Part D prescription drug coverage. Passcode: Medicare24!

This session offered insight on expansions to Medicare Part D prescription drug coverage in 2025 as required under the Inflation Reduction Act (IRA). These changes could impact whether an employer’s group health plan provides creditable prescription drug coverage. Plans that met creditable coverage status previously may no longer be creditable beginning in 2025. Employers offering prescription drug coverage need to be aware of these changes, take the necessary steps to understand the creditable status of their prescription drug plans for 2025 and clearly communicate status to eligible employees and report status to The Centers for Medicare & Medicaid Services (CMS).

Topics discussed during the session include:

Key Changes to Medicare Part D

The key changes to Medicare Part D for 2025 include a decreased maximum out-of-pocket limit of $2,000 and increased prescription drug coverage. A three-phase benefit structure will also be implemented which covers the deductible, initial coverage and catastrophic coverage. The coverage gap commonly known has the “donut hole” has been eliminated from the benefit structure. In addition, there will be no cost sharing for catastrophic coverage and a $35 cap on insulin cost-sharing costs.

Integrated vs. Non-Integrated Plan Requirements

To qualify as an integrated plan, prescription drug benefits must be combined with other employer-provided coverages such as medical, dental and vision along with having combined deductibles, annual maximums and lifetime maximums. Non-integrated plans must have no annual benefit maximum or a maximum of $25,000 or more, or an actuarial expectation of at least $2,000 in annual payments.

Determining Eligible Coverage

Employers must determine if their coverage is creditable, notify eligible participants and report status to CMS. Creditable coverage is defined as coverage with an actuarial value that is equal to or exceeds the actuarial value of standard prescription drug coverage under Medicare Part D, but employers are not required to offer it. Often, an insurance carrier or third-party administrator (TPA) will provide information to a plan sponsor detailing whether a plan’s drug coverage is creditable. However, if a plan sponsor does not receive this information from the carrier or TPA, the plan sponsor is responsible for making the determination using the simplified method or an actuarial determination.

How URA Can Help

Please contact your URA Sales or Service teams with any questions. We have access to resources and tools to assist with the determination of the credibility of your plans. In addition, UROne Benefits offers a variety of resources and services to assist plan sponsors, employees and dependents with the navigation of Medicare. Aside from assistance with Medicare open enrollment (October 15^th – December 7^th) we provide:

• Quarterly and on-demand Medicare 101 Webinars
• Support for those turning 65 or working past 65
• Medicare Products
  • Medicare Advantage Plans (MAPD)
  • Medicare Supplemental Plans
  • Part D (Rx Plans)
  • Dental/Vision/Hearing
  • Cancer/Heart Attack

Access the full webinar to learn more about the upcoming changes to Medicare Part D here. Passcode: Medicare24!