In early October, many health plans released information webpages, microsites, and calculators related to the Medicare Prescription Payment Plan in preparation for the 2025 Medicare Advantage Open Enrollment period.
To help health plans review what information competitors include on their websites, we’ve created this brief overview of a sampling of health plan Medicare Prescription Payment Plan webpages.
What is the Medicare Prescription Payment Plan?
The Medicare Prescription Payment Plan is a new payment option available to individuals with Medicare Part D coverage, starting in January 2025. Mandated by the Inflation Reduction Act, eligible members pay for their covered Part D prescription drug costs in monthly installments rather than upfront at the pharmacy. While the program does not reduce overall drug costs, it provides a way to manage expenses by spreading them throughout the year.
What is a health plan’s role in the Medicare Prescription Payment Plan?
Health plans have a multi-faceted role in managing the Medicare Prescription Payment Plan. They are involved in enrollment, communication, claim processing, billing and delinquency management, payment management, and disenrollment. They act as the primary point of contact for participating members and have recently created webpages with more information about the Medicare Prescription Payment Plan.
What information do plans include on health plan Medicare Prescription Payment Plan webpages?
We reviewed nearly 15 health plan websites, and most include:
Explanation of the Program’s Basics
The Medicare Prescription Payment Plan webpages consistently explain that the Medicare Prescription Payment Plan, starting in 2025, is a new, optional payment program that allows eligible Medicare Part D enrollees to pay for their covered prescription drugs in monthly installments instead of all at once at the pharmacy. The plan does not lower overall drug costs but helps manage out-of-pocket expenses by spreading them throughout the year.
Target Audience
The webpages generally describe which Medicare Advantage members are most likely to benefit from the program, including those who anticipate high drug costs early in the year, especially if they are likely to reach the $2,000 out-of-pocket maximum. They also suggest that the program may not be suitable for individuals with consistently low drug costs or those who receive assistance through programs like Extra Help or Medicare Savings.
Monthly Billing Process
The webpages frequently describe how to calculate monthly bills. They emphasize that the monthly payment amount can vary, and it is determined by dividing the total cost of prescriptions, including any outstanding balance from the previous month, by the number of months left in the plan year. They also caution that future payments might increase if filling a new prescription because it adds to the overall cost with fewer months remaining to spread out the payments. The sources often include examples to illustrate how this calculation works in various scenarios.
In addition to the common elements above, the webpages often provide contact information for assistance and highlight the availability of resources such as fact sheets and online tools to help individuals make informed decisions about the Medicare Prescription Payment Plan.
What answers to frequently asked questions are provided?
Many plan websites contain answers to frequently asked questions. Those questions include:
- What is the Medicare Prescription Payment Plan?
- How does the MPPP work?
- Will the MPPP save me money or lower my prescription drug costs?
- Does this program help pay for my medications? Who is most likely to benefit from the payment plan?
- How do I know if the payment plan is right for me?
- Will the payment plan still benefit me if I qualify for financial assistance?
- How is my monthly bill calculated?
- Can I see examples of how the payment plan may or may not benefit me?
- How do I pay my monthly bill?
- How do I opt-in to the prescription payment plan?
- Do I need to sign up every year?
- Can I opt out of the program?
- What if I change plans?
- What if I filled an urgent prescription before I was able to join the plan?
- How can I file a complaint or grievance about the payment plan?
- I have limited income and resources. What programs can help lower my drug costs?
Do plans have tools to help Medicare Advantage beneficiaries estimate their monthly costs?
Some Medicare Advantage Prescription Payment Plan webpages include tools that enable beneficiaries to estimate their costs. For example, Humana offers a great tool that allows beneficiaries to input their expected monthly prescription costs and then calculate their monthly bill if they enroll in the Medicare Prescription Payment Plan. Other health plans refer to the sample calculations developed by The Centers for Medicare and Medicaid (CMS) in their fact sheet. Others link to CMS’ tool that helps beneficiaries determine if the Medicare Prescription Payment Plan is a good fit.
Certifi’s Medicare Prescription Payment Plan billing and payment solutions help Part D plan sponsors and PBMs save time and improve M3P billing accuracy.
