Medicare Prescription Payment Plan

[kgmom219]

Link: [EXTERNAL LINK] - Adobe Acrobat

Mom says: Total Disaster Time. Its one page after another of CMS telling the carriers how to implement it and there's no way its going to work in 2025. Or probably 2026 and 2027. It normally takes 3 years for all the bugs to get worked out.

HIGHLY RECOMMEND reviewing the examples beginning on Page 49.

Mom's Notes

1. Beginning in 2025, there is a $2K Out of Pocket Maximum on Medicare Part D. (Which includes both standalone Part D and MAPD.)
2. The $2K includes the Part D deductible.
3. CMS has directed all plan sponsors to implement the “Medicare Prescription Payment Plan”, which is part of the IRA of 2022.
4. The payment plan will allow beneficiaries to pay the $2K over time vs sticker shock at the pharmacy.
5. Plan Sponsors (insurance companies) are responsible for the implementation, applications and management of the program.
6. Current enrollees who have reached $600 of out of pocket costs will be notified <by some specific date, but I can’t find it anywhere> and throughout the year.
7. LIS (Low Income Subsidy) beneficiaries are included in the notification requirements and should be encouraged to enroll.
8. Part D sponsors have 24 hours to effectuate a payment plan election mid-year. (Page 29)
9. Retroactive Enrollments are permitted and a required option (Page 30)
10. Once you enroll in the plan its not an automatic payment until after prescriptions are purchased. (Pages 49-53)
11. Pharmacies are notified at POS (Point of Sale) that the patient has enrolled in the program.
12. $2000/12 is $166.67. However, based on actual fill date, it may be more, based on actual fill date, with a lump sum due in December.
13. All ID cards will include the information (Page 69)
14. Enrollment changes: Payment plan does NOT move with the new plan. Old plan will continue to bill and offer a lump sum option. New plan follows the guidelines. (Page 75)
15. Grace Period is 2 months. (Page 77)
16. Lack of previous years payment does not preclude enrollment in following years payment plan

 

[Duaine]

Another big government success..."Oh, the humanity."

 

[somarco]

I give up.

Where is page 49?

 

[Russ]

Link: [EXTERNAL LINK] - Adobe Acrobat

Mom says: Total Disaster Time. Its one page after another of CMS telling the carriers how to implement it and there's no way its going to work in 2025. Or probably 2026 and 2027. It normally takes 3 years for all the bugs to get worked out.

HIGHLY RECOMMEND reviewing the examples beginning on Page 49.

Mom's Notes

1. Beginning in 2025, there is a $2K Out of Pocket Maximum on Medicare Part D. (Which includes both standalone Part D and MAPD.)
2. The $2K includes the Part D deductible.
3. CMS has directed all plan sponsors to implement the “Medicare Prescription Payment Plan”, which is part of the IRA of 2022.
4. The payment plan will allow beneficiaries to pay the $2K over time vs sticker shock at the pharmacy.
5. Plan Sponsors (insurance companies) are responsible for the implementation, applications and management of the program.
6. Current enrollees who have reached $600 of out of pocket costs will be notified <by some specific date, but I can’t find it anywhere> and throughout the year.
7. LIS (Low Income Subsidy) beneficiaries are included in the notification requirements and should be encouraged to enroll.
8. Part D sponsors have 24 hours to effectuate a payment plan election mid-year. (Page 29)
9. Retroactive Enrollments are permitted and a required option (Page 30)
10. Once you enroll in the plan its not an automatic payment until after prescriptions are purchased. (Pages 49-53)
11. Pharmacies are notified at POS (Point of Sale) that the patient has enrolled in the program.
12. $2000/12 is $166.67. However, based on actual fill date, it may be more, based on actual fill date, with a lump sum due in December.
13. All ID cards will include the information (Page 69)
14. Enrollment changes: Payment plan does NOT move with the new plan. Old plan will continue to bill and offer a lump sum option. New plan follows the guidelines. (Page 75)
15. Grace Period is 2 months. (Page 77)
16. Lack of previous years payment does not preclude enrollment in following years payment plan

Let me condense the 16 listings. It's a bunch of bullsh*t.

Makes note to self..."(PDP's)probably not worth the time"

Another note..."wait til they see the increase in premiums!"

 

[kgmom219]

I give up.

Where is page 49?

Did you click on the link at the top?

 

[somarco]

Did you click on the link at the top?

Yes . . . only 1 page opened up.

 

[kgmom219]

Yes . . . only 1 page opened up.

I emailed it to you. But here's the site, too: [EXTERNAL LINK] - Contract Year 2025 Medicare Advantage and Part D Final Rule (CMS-4205-F) | CMS