As a result of the Inflation Reduction Act, starting 1/1/2025, regardless of if you have a Medicare Advantage plan or a stand-alone Prescription Drug plan, there are changes coming to the way your prescription drugs are covered. The changes include:
- $2,000 yearly maximum out-of-pocket on covered prescriptions
- Elimination of the Part D Coverage Gap (A.K.A. Donut Hole)
- Introduction of the Medicare Prescription Payment Plan (M3P)
What is the Medicare Prescription Payment Plan (M3P)?
The Medicare Prescription Payment Plan, formerly known as the “Smoothing Provision”, requires Part D plan sponsors to provide enrollees with the option to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year instead of all at once to the pharmacy.
The program begins on January 1, 2025. Participants will pay $0 to the pharmacy for covered Part D drugs, and Part D plan sponsors will then bill program participants monthly for any cost sharing they incur while in the program.
Participants can begin signing up for the program 10/15/2024 over the phone, online, or with a paper form directly with their plan sponsor. Members may opt into the program prior to the beginning of the plan year or in any month during the plan year. Enrollment must happen before the program is used at the pharmacy. Agents cannot help with enrollment.
This is an “all or none” program. Meaning all prescriptions must be paid monthly or none. Participants cannot pick and choose which prescriptions to apply to the program.
If you would like to learn more about the Inflation Reduction Act and how it may affect your coverage, we’ve created an extensive writeup on that legislation – for more information: click here.
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