2025 Medicare Part D Plans in New York State - with changes from 2024

The Annual Enrollment Period ("AEP" or "open enrollment") for Medicare Part D and Medicare Advantage plans for 2025 runs from October 15 through December 7, 2024.    

For 2024 plan lists - click here.   Read below for 2025 plan lists. 

Every year, you should review your plan options to see if your current plan still meets your needs - see more here on what to look for in the CMS Planfinder. Click here for How to use Medicare Plan Finder, step-by-step - by CMS.

2025 - NEW - Out of Pocket Limit Goes Down to $2000  - this is a big reduction in maximum out of pocket costs for consumers, as enacted in the Investment Recovery Act (IRA).  See A Current Snapshot of the Medicare Part D Prescription Drug Benefit (Kaiser Family Foundation)...

Part D Cost-Sharing Chart - Download from NCOA here (2024 chart will be updated for 2025 soon)

2024 "Extra Help" Expansion - read here and Read about other 2024 changes here

2024-25 CMS Guide to Consumer Mailings - Notices sent about plan closings, reassignments, Extra Help.

2025 Part D and Medicare Advantage plans - from lists posted here by CMS.  

1.  Stand Alone Part D Prescription Drug Plans (PDP) -  (PDF)(Excel) (12 plans (down from 15 in 2024)  in New York State for people in Original Medicare. Chart shows the 2025 and the 2024 premium for comparison, and the 2025 premium for those with Full Extra Help.   Updated chart includes Star Ratings. 

   • THREE (3) "BENCHMARK" STAND-ALONE PDP PLANS have a FREE PREMIUM for people with FULL "EXTRA HELP" (Low Income Subsidy) - this chart shows changes from 2024.  This is up from two "benchmark" plans in 2024.

   • Benchmark Premium is  $72.34 in 2025, up from $48.72  in 2024

     • People enrolled in Extra Help, either because they were approved for Medicaid or a Medicare Savings Program or because they applied to the SSA for Extra Help, are assigned to a benchmark plan if they don't pick one themselves and enroll.

     • People with Extra Help who enroll in a plan other than the 3 "benchmark plans" pay a reduced premium, shown on the chart.

     • All 3 benchmark plans have a Star Rating of 2.5 in 2025. 

   • One plan, SilverScript Choice (Aetna) is once again a "benchmark" in 2025, after not being a benchmark plan in 2024.  Also, members of the following two Silverscript plans in 2024 will be assigned to SilverScript Choice for 2025 unless they select a different plans -- SilverScript SmartSaver (PDP) and Silverscript Plus (PDP).    . 

   • No stand-alone drug plans are closing entirely in 2025, but some plans are consolidating with other plans or changing their names.  See chart. 

   • Lowest premium for a stand-alone plan (for those without Extra Help) is $38.80)

2. Medicare Advantage (MA) 2025 Plans in NYA (MA-PD) - EXCEL  --1st tab is Statewide list by county, followed by separate tabs for NYC MA plan and statewide list ofSpecial Needs Plans (SNP).  Also see changes from 2024 in your county on q1Medicare.com (source for some info added to this chart).

   • 280 MA plans in NYS in 2025, up from 241 plans in 2024.

   • The popular Excellus Medicare Blue Choice Access (PPO) closed, which was in Monroe, Ontario, Seneca, Wayne & Yates  counties.   Excellus launched  a new PPO Medicare Blue Choice Discovery in those counties, and a new Univera SeniorChoice Core (PPO) in Erie and seven other upstate counties.  

3. NYS Special Needs Plans 2025  (SNP)  - (Third tab) Will be updated to show which plans are affiliated with a Medicaid Advantage Plus plan (also known as FIDE for Fully Integrated Dual Eligible).  See more about "default enrollment" into SNPs here

INSULIN - $35 CAP started in 2023!!! 

The $35 Insulin Senior Savings Model, which began in 2021 and extended into 2022, changed in 2023. Starting 2023, insulin has a copay price cap at $35 for a one-month supply as long as it is a brand APPROVED/COVERED by your Medicare Part D insurance plan, including during your deductible period and donut hole.  You can find more information here on the Medicare government website.

Helpful information about \ Medicare Part D -

• National Council on Aging (NCOA): What is Medicare and How Do I Get Started?

• National Council on Aging (NCOA): How to Choose a Medicare Plan During Open Enrollment

• What to review ever year - because plans change and your drug needs change

  • Are your prescriptions on the plan's formulary (which may change year to year), in the dosage and strength that you take? Are there new "utilization review" limits such as quantity limits or prior approval requirements?  

  • Have premium, deductible, and coinsurance costs increased?   

  • If you are in a Medicare Advantage plan, are your preferred doctors and other providers in network, and have the costs increased? (coinsurance, deductible, premium) 

  • See more Questions to Ask when Comparing Part D Plans

The lists posted here are extracted from nationwide charts on the CMS website at http://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn/. Sanctioned plans are also available at that link. Some extra information was added to the above charts by NYLAG, including some comparisons from 2024 plans, sourced from 2024 chart and q1Medicare.com.

2024 Plan Lists

1. Stand Alone Part D Prescription Drug Plans (PDP) -  (PDF) 

2. Medicare Advantage (MA) Plans (MA-PD) - (Excel) offered in NYS -  Also see changes from 2024 in your county on q1Medicare.com (source for some info added to this chart).

3. NYS Special Needs Plans (SNP) - (Excel) showing which plans are affiliated with a Medicaid Advantage Plus plan (also known as FIDE for Fully Integrated Dual Eligible).