The State of Maryland’s prescription drug plan coverage for Medicare-eligible retirees is changing on January 1, 2025.
The current State-provided prescription drug plan for Medicare-eligible retirees will end on December 31, 2024. Retirees will need to enroll in a Medicare Part D plan during Medicare open enrollment between October 15 and December 7, 2024, to have prescription drug coverage on January 1, 2025. You will select a Medicare Part D plan from the options that will be available in your geographic area. To assist you with this transition, the State will provide one-on-one counseling to walk through your options with you this Fall.
We realize this is a big change, and you probably have many questions and concerns. We are committed to ensuring a smooth transition to your new coverage, including providing one-to-one counseling assistance in selecting a Part D plan. As soon as we have more details to share, our team at the Department of Budget and Management will answer all your questions and address your concerns.
The current State-provided prescription drug plan for Medicare-eligible retirees will end on December 31, 2024. Retirees will need to enroll in a Medicare Part D plan during Medicare open enrollment this fall (October 15 – December 7), to have prescription drug coverage on January 1, 2025. You will need to select a Medicare Part D plan from the options that will be available in your geographic area. To assist you with this transition, the State will provide one-on-one counseling to walk through your options and enroll you in a plan this fall.
The changes are happening due to Maryland state law to address both the long-term affordability of the State-funded plan and the planned benefit improvements in Medicare Part D.
No. Other State of Maryland-sponsored health care coverage for actives and retirees—and Medicare Part A and Part B coverage—are not affected by this change.
All Medicare-eligible retirees as of January 1, 2025, Medicare-eligible spouses and surviving spouses, and Medicare-eligible dependent children and surviving children are affected.
Non-Medicare-eligible retirees, non-Medicare-eligible spouses, and non-Medicare-eligible dependent children are not affected by this change and remain eligible for the State plan.
No. To have prescription drug coverage on January 1, 2025, you will need to select a Medicare Part D plan from the options that will be available in your geographic area during Medicare open enrollment this fall (October 15 – December 7).
Medicare covers prescription drugs through Part D prescription drug plans. These plans must follow rules established by the federal government. Each Medicare plan must give at least a standard level of coverage set by Medicare. Medicare plans can vary on pharmacies they use, prescription drugs they cover, and how much they charge.
All Part D prescription drug plans must cover a wide range of prescription drugs. Each plan will publish a list of its covered drugs, so retirees can understand which plan covers the medications they will need and how much they will cost. The list of covered drugs may be different from the State's current plan, so it's important to take advantage of the one-on-one counseling so you can understand which Part D plan will cover the drugs you need.
The following categories of drugs are not covered under Medicare Part D:*
* Note: Prescription drugs used for the above conditions may be covered if they are being prescribed to treat other conditions. For example, a medicine for the relief of cold symptoms may be covered by Part D if prescribed to treat something other than a cold (e.g., shortness of breath from asthma) that is approved by the FDA.
The Inflation Reduction Act includes several provisions to lower prescription drug costs for people with Medicare and reduce drug spending by the federal government, including several changes to the Medicare Part D drug benefit.
In 2025, the annual out-of-pocket (OOP) amount payable by retirees who have Part D coverage will be limited to $2,000. Enrollees who surpass the $2,000 OOP threshold will no longer incur cost sharing for Part D drugs for the remainder of the calendar year.
The specific details of the cost and benefits coverage in 2025 Medicare Part D prescription drug plans are not yet available. We expect the details of the 2025 plans to be available in early fall (they are typically released in September). The State is in the process of contracting with a plan administrator that will have licensed benefits counselors to help you understand how the plans work and assist you in selecting a plan during open enrollment. The list of covered drugs may be different from the State's current plan, so it's important to take advantage of the one-on-one counseling so you can understand which Part D plan will cover the drugs you need.
All Part D plans include a formulary of preferred drugs. Not every drug within a therapeutic class is covered by every plan, but there are alternatives available under each class. Through the one-on-one counseling services, licensed agents will assist you with selecting the best plan for you based on your personal needs.
If you select a Part D plan that does not include on its formulary a current prescription drug that you are taking, you will have an option to substitute a therapeutic equivalent drug or seek a prior authorization to use that drug. We encourage you to speak with your physician about alternatives that align with your selected formulary. Approved prior authorizations will be covered under your plan and count toward your out-of-pocket maximum.
No. Inpatient hospital charges, including drugs administered during the stay, are paid through Medicare Part A.
Generally, Part B covers outpatient services, such as physician visits, lab, and X-rays. Part B also covers outpatient drugs like:
A full description can be found in the Medicare and You guide beginning on page 29: medicare.gov/publications/10050-Medicare-and-You.pdf