anybody else think this is not going to end well?
explanation from AHIP:
36. New for 2025: The Medicare Prescription Payment Plan (1 of 3)
Beginning in 2025, Part D sponsors are required to provide all Part D enrollees the option to pay their cost-sharing amounts (including any deductibles, copayments, or coinsurance) in monthly amounts spread out over the plan year, instead of paying them in full at the point of service (e.g., the pharmacy).
•
Part D enrollees can opt into the Medicare Prescription Payment Plan (“the program”) at the beginning of the year or any point during the year.
•
Part D enrollees who choose to participate in the program pay nothing at the point of service for a Part D covered drug but are billed each month by their Part D plan.
•
Monthly payments do not start until the beneficiary opts into the program and first incurs out-of-pocket costs for covered Part D drugs.
11
•
The amount that the Part D sponsor bills the enrollee for a month under the program cannot exceed a maximum monthly cap, calculated based on each enrollee’s costs and the point in the plan year in which they enrolled in the program. The monthly cap varies from month to month.
•
Opting into the program will not impact how a Part D enrollee moves through the phases of the Part D benefit (i.e., deductible, initial coverage period, and catastrophic coverage) or what counts towards their true out-of-pocket (TrOOP) costs.
37. The Medicare Prescription Payment Plan (2 of 3)
•
The program is intended to allow beneficiaries to spread out their cost-sharing obligations throughout a plan year.
•
While this program is available to any Part D enrollee, those incurring high out-of-pocket costs earlier in the plan year are generally more likely to benefit.
•
Part D enrollees with low-to-moderate recurring out-of-pocket drug costs (e.g., maintenance drugs whose annual costs are not expected to exceed the out-of-pocket threshold) are not likely to benefit from the Medicare Prescription Payment Plan because their costs are already distributed evenly throughout the year.
38. The Medicare Prescription Payment Plan (3 of 3)
•
Enrollees can opt out of the program at any time. However, they will continue to be billed monthly for any cost-sharing amounts still owed.
•
Failure to pay the monthly billed amount will result in disenrollment from the program (but not the plan) after a specified grace period. However, the Part D sponsor will continue to bill amounts owed under the program in monthly amounts. The sponsor may also offer the beneficiary the option to repay the full outstanding amount in a lump sum.
•
Once a beneficiary leaves the program, they must resume paying their out-of-pocket cost sharing at the point-of-service.
explanation from AHIP:
36. New for 2025: The Medicare Prescription Payment Plan (1 of 3)
Beginning in 2025, Part D sponsors are required to provide all Part D enrollees the option to pay their cost-sharing amounts (including any deductibles, copayments, or coinsurance) in monthly amounts spread out over the plan year, instead of paying them in full at the point of service (e.g., the pharmacy).
•
Part D enrollees can opt into the Medicare Prescription Payment Plan (“the program”) at the beginning of the year or any point during the year.
•
Part D enrollees who choose to participate in the program pay nothing at the point of service for a Part D covered drug but are billed each month by their Part D plan.
•
Monthly payments do not start until the beneficiary opts into the program and first incurs out-of-pocket costs for covered Part D drugs.
11
•
The amount that the Part D sponsor bills the enrollee for a month under the program cannot exceed a maximum monthly cap, calculated based on each enrollee’s costs and the point in the plan year in which they enrolled in the program. The monthly cap varies from month to month.
•
Opting into the program will not impact how a Part D enrollee moves through the phases of the Part D benefit (i.e., deductible, initial coverage period, and catastrophic coverage) or what counts towards their true out-of-pocket (TrOOP) costs.
37. The Medicare Prescription Payment Plan (2 of 3)
•
The program is intended to allow beneficiaries to spread out their cost-sharing obligations throughout a plan year.
•
While this program is available to any Part D enrollee, those incurring high out-of-pocket costs earlier in the plan year are generally more likely to benefit.
•
Part D enrollees with low-to-moderate recurring out-of-pocket drug costs (e.g., maintenance drugs whose annual costs are not expected to exceed the out-of-pocket threshold) are not likely to benefit from the Medicare Prescription Payment Plan because their costs are already distributed evenly throughout the year.
38. The Medicare Prescription Payment Plan (3 of 3)
•
Enrollees can opt out of the program at any time. However, they will continue to be billed monthly for any cost-sharing amounts still owed.
•
Failure to pay the monthly billed amount will result in disenrollment from the program (but not the plan) after a specified grace period. However, the Part D sponsor will continue to bill amounts owed under the program in monthly amounts. The sponsor may also offer the beneficiary the option to repay the full outstanding amount in a lump sum.
•
Once a beneficiary leaves the program, they must resume paying their out-of-pocket cost sharing at the point-of-service.
