Recent legislation resulted in several changes to Medicare Part D. Among the lessor known changes is the ability for beneficiaries to pay their out-of-pocket costs over a year rather than when obtaining a prescription.
CMS is developing rules on exactly how this will work – a fact sheet from CMS is shown below. How valuable this will be remains to be seen, but I see a great potential for confusion among beneficiaries – more choices to make and planning for the unknown financial future over a year. For example, CMS proposes that if a beneficiary does not pay what is owed, they are kicked out of the payment program, but can’t be removed from their Part D coverage – somebody is left holding the bag.
What Changes Are Being Made to Part D?
KFF.org
- As of 2023, the out-of-pocket cost of insulin products is limited to no more than $35 per month in all Part D plans. In addition, adult vaccines covered under Part D, such as the shingles vaccine, are covered with no cost sharing.
- Starting in 2024, people with Medicare who have incomes up to 150% of poverty and resources at or below the limits for partial low-income subsidy benefits will be eligible for full benefits under the Part D Low-Income Subsidy (LIS) Program. The law eliminates the partial LIS benefit currently in place for individuals with incomes between 135% and 150% of poverty.
- Also starting in 2024, the calculation of the base beneficiary premium will be adjusted, as needed, to limit increases in the base premium to no more than 6% from the prior year. (Premiums for individual Part D plan premiums and annual plan-level premium increases will continue to vary, however.)
- Starting in 2025, Part D enrollees will have the option of spreading out their out-of-pocket costs over the year rather than face high out-of-pocket costs in any given month.
CMS said it will develop tools to help beneficiaries decide if the program will be helpful. Although the program will not reduce overall out-of-pocket costs, spreading the costs throughout the year can help ease some of the payment burden, according to the CMS announcement. Additionally, beneficiaries will owe nothing upfront when picking up medication at the pharmacy.
The Senior Citizen League
The following is worth reading
QUINNSCOMMENTARY 
“CMS proposes that if a beneficiary does not pay what is owed, they are kicked out of the payment program, but can’t be removed from their Part D coverage – somebody is left holding the bag.”
I hope CMS is smart enough to start charging people who get kicked out of the payment program, the full copay at time of new drug purchases.
I am sure glad I served 20 years in the USAF. Once Medicare pays the 80% my Tricare for Life military insurance picks up the 20%, so no copays for me. All my drugs are free at any military base and the most I have ever paid for a drug purchased off base is $30.
LikeLike