Med D Madness: Here's the Scoop by Angie Lee
Aug 24, 2024
By Angela Lee, Director of Operations at BC Educators
The world of access is ever changing, and it can often feel overwhelming trying to navigate through the chaos. Here are some highlights I'd like to share with you all regarding the changes for 2025.
Navigating the New Medicare Prescription Payment Plan (MPPP) in 2025:
What You Need to Know
In the ever-changing world of healthcare access, staying updated on the latest programs and regulations can feel overwhelming, especially with the constant flux in policies affecting prescription costs. As we look ahead to 2025, some significant changes are coming, particularly with the Medicare Prescription Payment Plan (MPPP). For healthcare providers, understanding these shifts can be essential in helping patients make informed decisions.
Let’s break down the highlights of the MPPP and what it means for your Medicare patients:
What is the MPPP?
The MPPP offers a new way for Medicare patients to manage their prescription drug expenses. Once a patient reaches the $2,000 out-of-pocket (OOP) cap under Medicare Part D, they can opt into this program, allowing them to spread out their costs over monthly installments. While this doesn’t reduce the total expense, it provides a more manageable payment structure. Think of it as a payment plan, where patients can budget for their drug costs throughout the year rather than face one large bill upfront.
Who is Eligible?
This program is available to anyone with Medicare Part D coverage, but it’s not automatic. Patients must actively opt in to participate. While plan sponsors will notify eligible individuals, it’s essential that patients pay attention to these communications to enroll in the program if they choose.
How Does It Work?
Once enrolled, patients will make monthly payments directly to their drug plan—not to the pharmacy. These payments may fluctuate, and it’s important to note that missing a payment could result in being dropped from the MPPP (though they won’t lose their overall drug plan). Additionally, the MPPP only covers drugs listed in the Part D plan’s formulary, and there won’t be any extra copayments or cost-sharing at the pharmacy.
Is the MPPP Beneficial for Everyone?
Not necessarily. The MPPP is designed to ease financial pressure by spreading costs over time, but it doesn’t reduce the actual amount owed. For patients with lower drug costs or those who reach the OOP cap late in the year, this program may not be the best fit. It’s essential for patients to weigh their options based on their specific circumstances.
Key Considerations for Your Patients
As a healthcare provider, it’s important to advise your Medicare-aged patients to keep an eye on communications from their drug plans and Medicare. They should carefully consider how joining the MPPP could impact their overall drug costs and payment schedules.
The $2,000 Cap and Employer-Provided Drug Coverage: What Patients Should Know
For patients with employer-provided drug coverage, the new $2,000 out-of-pocket cap in Medicare Part D could have significant implications. Here’s what your patients need to keep in mind:
1. Creditable Coverage Matters
Employer plans must meet Medicare’s “creditable” coverage standard, meaning they must cover as much as a typical Medicare Part D plan. If a patient’s employer plan isn’t creditable, they could face penalties when they eventually enroll in Part D. This makes it critical for patients to verify their plan’s status each year.
2. IRA Provisions May Impact Creditable Coverage
New provisions from the Inflation Reduction Act (IRA), such as the $2,000 OOP cap and no cost-sharing for vaccines, could make it harder for employer plans to maintain creditable status. This could influence a patient’s decision to stay with their employer plan or switch to Medicare Part D.
3. Keep Those Annual Notices
Every year by October 15, patients should receive a notice from their employer stating whether their drug coverage is creditable. This notice is essential for making informed decisions about Medicare enrollment in the future.
4. Weighing the Costs and Benefits
Patients need to carefully evaluate whether to stay with a non-creditable employer plan or switch to Medicare Part D. Factors like potential penalties, premiums, and the long-term benefits of each option should be considered.
5. Timing is Key
Patients should aim to make their coverage decisions during Medicare’s Open Enrollment Period (October 15 to December 7). This helps them avoid penalties and ensures a smooth transition if they choose to switch plans.
Action Steps for Your Patients
Encourage your patients to assess their current coverage, monitor for creditable coverage notices, and stay informed about the changing landscape of Medicare Part D. These decisions can have lasting implications, especially as they approach retirement. By staying proactive, patients can make the best choices for their healthcare needs in 2025 and beyond.
By breaking down the MPPP and Medicare updates in simple terms, you’ll empower your patients to navigate these changes with confidence. After all, a well-informed patient is a healthier patient!
Reference: