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Understanding the 2025 Medicare Part D $2,000 Cap

What You Need to Know About the New Prescription Drug Coverage Limits

2025 Medicare Part D Changes

$ What's Covered Under the Cap

✔︎ Medications on your plan's formulary

✔︎ Part D covered prescriptions

✔︎ Approved formulary exceptions

❌ Monthly plan premiums

❌ Non-formulary medications

❌ Over-the-counter drugs

Prescription Drug Coverage Details

 ✔︎ How Aurora Health Can Help

  • Comprehensive plan comparison and analysis

  • Expert guidance on enhanced vs. basic plans

  • Formulary review and optimization

  • Cost-saving strategies identification

  • Personalized coverage recommendations

Cost Savings Opportunities

 📝 Key Considerations for 2025

​Enhanced vs. Basic Plans

Enhanced plans may offer significant advantages under the new cap structure. With enhanced plans, you might reach the $2,000 cap without actually spending $2,000 out-of-pocket, while basic plans require full payment to reach the cap.

​Cost Calculation Changes

The way costs count toward your cap depends on your plan type. Enhanced plans use the greater of your actual costs or standard benefit costs, while basic plans only count actual out-of-pocket expenses.

Why Choose Aurora Health?

Our team specializes in analyzing these complex changes to help you maximize your benefits. We can help you:

  • Navigate the new coverage phases

  • Compare enhanced and basic plan options

  • Understand true out-of-pocket (TrOOP) calculations

  • Find plans with optimal copay structures

  • Minimize your total annual costs

Medicare Part D Assistance

Get Expert Help with Your Medicare Decisions

Don't navigate these changes alone. Let our experts help you find the most cost-effective coverage for your needs.

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