Prescription Coverage

Changes to your Medicare prescription benefit (Part D) for 2025

Here are some changes to your individual Medicare Advantage prescription benefit for this year:

• The donut hole or coverage gap phase was eliminated.
• The annual out of pocket maximum is $2,000 (in 2024 it was $8,000).
• The Medicare Prescription Payment Plan (commonly referred to as M3P) allows you to pay for your prescriptions in monthly payments to HAP over time instead of at the pharmacy counter.
• There are drug coverage changes including tiering, copay, and deductible.

Prescription drug stages

For 2025 the Medicare Part D structure consists of three stages:

Stage 1 - If your plan has a deductible, you need to pay that deductible to enter the next stage of coverage.

Stage 2 - The initial coverage stage occurs after the deductible is met. You will have a copay or coinsurance until your $2,000 out-of-pocket maximum is reached. This stage is where you will spend the majority of your prescription drug costs, and it covers both generic and brand-name drugs.

Stage 3 – You’ve reached $2,000 in out-of-pocket costs, including your payments and those of others who pay on your behalf. This stage is called the catastrophic phase of coverage. You will pay nothing for covered drugs for the remainder of the coverage year.

These changes mean you will pay most of your drug costs earlier in the year compared to 2024, when you may have paid higher costs at the end of the year. 

Tools to help you find and compare prescription drugs covered by Medicare and benefits

We make every effort to ensure you receive safe, appropriate drugs. We have Medication Therapy Management and Utilization Management programs in place to identify potential problems and resolve them before they become an issue.

We also have a tool to make comparing drug plans simpler. If you're concerned about how to pay for your prescription drugs, we may be able to help with that, too.

Compare prescription drug benefits and costs

If your medication is covered by your Medicare insurance, you can use our online tool Express Scripts to compare prescription drug benefits across different plans. You also can compare plan options against current medication costs to choose the plan that best meets your needs. To use Express Scripts and see if your medication is covered, select your plan type below:

Medicare Advantage Plans 2025

• HAP Medicare Connect (HMO)
• HAP Henry Ford Select (HMO)
• HAP MSU-HC Medicare (HMO)
• HAP Medicare MedicalAccess (HMO)
• HAP Senior Plus Henry Ford Tiered Access (HMO)
• HAP Senior Plus (HMO-POS)
• HAP Member Assist (PPO)
• HAP MSU-HC Medicare Prime (PPO)
• HAP Medicare Explore (PPO)
• HAP Senior Plus (PPO)
• HAP Medicare Complete Duals (HMO D-SNP)
• HAP Medicare Complete Assist (PPO D-SNP)

Pick a plan and provide your ZIP code and medications. The tool does the rest. You'll be able to see premium costs, deductibles, initial costs and what you might pay during a coverage gap period.

Find out if your Medicare plan covers your prescription drug