How will part D smoothing of payments work ?

[Special Agent]

All I see is consumers getting more in debt. As more meds are prescribed, balance only gets bigger, year after year.

And more pdp carriers leaving. Who wants to give interest free loans out and incur administration costs?

I can see the misleading FB ads now - Free Pill Day Loans!

 

[DonP]

There is no minimum Rx amount; anyone can enroll into the Medicare Prescription Payment Plan (CMS dropped the "smoothing" name a while ago). When I mean anyone, I mean anyone -- including those with Medicaid/Extra Help.

Clients will pay the carriers back. If someone changes carriers mid-year, the Rx balance does not transfer. The carrier can request a lump sum payment, but must still accept monthly payments through the remainder of the year.

So you're telling me if Peggy signs up with Humana 1/1/25 and does $166 a month Part D payments . During oep she's flipped to United for 4/1 effective date . You're telling me the carrier can demand the 9 remaining months of $166? What if she doesn't pay ? Surely the 3 payments she paid of $166 almost equal her $590 part d Deductible . What if she pays nothing to old carrier what does new carrier charge here starting 4/1? That makes no sense . Part D rolls from carrier to carrier threw Medicare keeping track with nothing to do with carrier . What your describing means somebody on a payment plan will have a tough time switching plans .

 

[Millwood]

So you're telling me if Peggy signs up with Humana 1/1/25 and does $166 a month Part D payments . During oep she's flipped to United for 4/1 effective date . You're telling me the carrier can demand the 9 remaining months of $166? What if she doesn't pay ? Surely the 3 payments she paid of $166 almost equal her $590 part d Deductible . What if she pays nothing to old carrier what does new carrier charge here starting 4/1? That makes no sense . Part D rolls from carrier to carrier threw Medicare keeping track with nothing to do with carrier . What your describing means somebody on a payment plan will have a tough time switching plans .

Welcome to the Sheaught Show.
It's always the unintended consequences that have the most profound effects.
Just once it would be nice if the ones who have their boots on the ground (agents) were asked for advice.

 

[kgmom219]

Its not going to work in 2025. And probably not in 2026, either. Its a total mess, from how they determine the monthly amount (which can change monthly, BTW) to getting the information back to the pharmacy saying "pre-pay patient".

 

[Russ]

Its not going to work in 2025. And probably not in 2026, either. Its a total mess, from how they determine the monthly amount (which can change monthly, BTW) to getting the information back to the pharmacy saying "pre-pay patient".

It's too confusing and too much BS for all involved. With all of the changes with PDP is it even worth it for $100 or $50?

 

[wehotex]

So, who ends up taking the initial hit. The insurer or the pharmacy? Who does client pay monthly payments too? Insurer or pharmacy?

So what happens if the mb is given an EFT option or paper invoice and MISSES 2 or more payments?
Would the refill be rejected at the pharmacy after missing or could a carrier drop a member who is not paying the monthly premiums? It seems like it is open for abuse if the carrier doesn't REQUIRE that SS deduction is the only way to pay.

 

[Packerland]

It's too confusing and too much BS for all involved. With all of the changes with PDP is it even worth it for $100 or $50?

If only every agent would stop selling PDP'S I think the government would find out quickly how important our roles are in this whole process...

 

[TwoCents]

So what happens if the mb is given an EFT option or paper invoice and MISSES 2 or more payments?
Would the refill be rejected at the pharmacy after missing or could a carrier drop a member who is not paying the monthly premiums? It seems like it is open for abuse if the carrier doesn't REQUIRE that SS deduction is the only way to pay.

No, carriers are not allowed to term coverage due to non-payment of what's owed for Rx. Once removed from the drug payment plan, filling Rx would work like it always has -- pay the cost share at the pharmacy.

 

[wehotex]

No, carriers are not allowed to term coverage due to non-payment of what's owed for Rx. Once removed from the drug payment plan, filling Rx would work like it always has -- pay the cost share at the pharmacy.

So there isn't any bad consequence of stiffing the carrier?!!

 

[Millwood]

So there isn't any bad consequence of stiffing the carrier?!!

The Goverment is the Master of Unintended Consequences.