It’s not always easy to pay for the high cost of prescription drugs. But it just got a bit easier with the Inflation Reduction Act’s Medicare Prescription Payment Plan. Here’s what you need to know about swapping your out-of-pocket costs at the pharmacy for simple and affordable monthly payments.
The Inflation Reduction Act
The Inflation Reduction Act was designed to help those who depend on prescriptions to fight the ever-rising cost of medication in the United States. Starting in 2025, the Inflation Reduction act will enact the Medicare Prescription Payment Plan.
The Medicare Prescription Payment Plan allows Medicare Advantage and Part D enrollees the option to pay prescription drug costs with a capped monthly payment, rather than paying out-of-pocket at the pharmacy. It’s a simpler and more affordable alternative that could benefit many Medicare Part D members.
How the Medicare Prescription Payment Plan works
If you choose to take advantage of the Prescription Payment Plan, you won’t pay anything out of pocket for covered drugs when you visit the pharmacy. Just grab your medication and go!
Instead, your insurance company will pay the pharmacy directly for any prescription drugs, and you’ll get a monthly payment from the insurance company for any applicable cost-sharing. This means you can spread payments out over the months, rather than needing to come up with any cost-sharing expenses out of pocket when you visit the pharmacy.
There is a cap on the monthly payments, so you can feel confident knowing that you won’t ever exceed a set amount, making prescription medication that much more affordable on any budget. Participants can also not be terminated from their Part D plan if they’re unable to continue in the payment program.
The total out-of-pocket Medicare Part D drug costs will be the same with this new program, and it won’t affect how you progress through the Part D benefits, including deductibles and out-of-pocket thresholds. Everything else about your Medicare Part D plan remains the same. The only change is that you’re billed monthly for cost-sharing, rather than up front at the pharmacy.
When to enroll
If you think a Prescription Payment Plan might be right for you, you can opt in during Medicare Open Enrollment between October 15th and December 7th.
Payment plans will start in 2025. Current Medicare Part D enrollees will also have the opportunity to opt in throughout the year.
Is a Medicare Prescription Payment Plan right for you?
While the program is available to all Medicare Part D enrollees, it might not be right for every situation. You can find monthly cost estimators and other tools to help you decide whether you want to enroll in a Medicare Prescription Payment plan. Typically, those with high early-year costs will benefit the most from a Medicare Prescription Payment Plan.
If you need help deciding whether a payment plan is right for you, or if you need assistance navigating Medicare in general, please contact the local Medicare advisors at Health Benefits Associates at 775-828-1216. Our knowledgeable brokers can help you find a health insurance plan that’s right for your needs, so call today!
