Medicare Changes in 2025

By Carol Tordella & Rebecca Pauley

Support is available—here’s how to get it.
Navigating Medicare can be overwhelming, especially when you’re living with a serious or rare illness. But important changes took effect at the start of 2025 that may ease the financial burden—and programs like Accessia Health can help you manage the rest.

Medicare Part D is Capped at $2,000 for 2025
As of January 1, 2025, your out-of-pocket costs for prescription drugs under Medicare Part D are capped at $2,000 per year. This cap does not apply to medications billed under Medicare Part B (typically infusions or drugs administered in a clinical setting).

What’s the Medicare “Smoothing Plan”?
The Medicare Prescription Payment Plan (M3P) lets you spread your $2,000 out-of-pocket maximum over the year through monthly payments—rather than paying large costs all at once.

• You can still opt in anytime in 2025.
• The earlier you enroll, the more months you have to spread out payments.
• It works like an interest-free loan from your plan that you repay monthly.

Can You Still Get Financial Help?
Yes! Even if you’re enrolled in the smoothing plan, you can still apply for assistance from nonprofit programs like Accessia Health.
Timing matters:

• If you sign up for smoothing early in the year, you may qualify for reimbursement toward covered medications.
• If you enroll midyear, payments for medications already filled may not be eligible, but other types of support may still be available.

Reimbursement for Medicare Premiums
Many patients forget that Medicare premiums are usually deducted from their Social Security, meaning that money’s gone before they even see it.Accessia Health can reimburse those premiums, which is often one of the most effective ways to help patients stretch their income. 

Turning 65? Let Accessia Help
If you’re transitioning from a private plan to Medicare, you’ll need to shift to a public assistance program. That typically requires joining a waitlist. Accessia begins reaching out 18 months in advance to help patients prepare and avoid losing coverage during the switch.

Need Help Choosing a Plan?
Accessia Health has trained social workers who offer neutral guidance to help you compare Medicare and supplemental plans based on your treatment and prescription needs. They won’t choose for you—they’ll empower you with information.

Denied Disability? You’re Not Alone
Been denied Social Security Disability benefits? That can also affect your access to Medicare. Accessia offers free legal support for certain diagnoses (including GIST) to help you appeal. You just need to call and ask to speak to the ACCESS program.

To learn more about your rights as a patient, Triage Cancer hosts free educational events on the legal and practical issues that often arise after a cancer diagnosis. To see events coming up, visit their website: triagecancer.org/events

Bottom Line (as of July 2025)

• The $2,000 annual cap on Medicare Part D prescriptions is already in effect.
• The smoothing plan (M3P) is live, and patients can still opt in for monthly payments.
• Earlier enrollment helps reduce the size of each payment.
• You can still receive help from charitable assistance programs like Accessia—even if you’re using M3P.
• Reimbursement for Medicare premiums may be available to help make ends meet.
• Don’t wait to ask for help—getting on a waitlist early ensures you’ll be ready if your situation changes.

Let us help you navigate what’s next.
Call Accessia Health: 1-800-366-7741
Learn more and apply: https://patient.accessiahealth.org/application/start

Note: If the website says there is no funding available, continue the application to get on the wait list!