The Huge Medicare Prescription Drug Benefit You’ve (Probably) Never Heard Of

Do you or one of your family members get medications through Medicare? If so, it’s imperative to learn about the secret benefit every Federal bureaucrat knows about.

In January 2025, Medicare will roll out a new benefit that will help many enrollees better manage their out-of-pocket prescription drug expenses. But some of the important features aren’t automatic, meaning that you’ll have to sign up for them to be eligible. Healthy Men, Inc. applauds this new plan but is concerned that there are too many beneficiaries who won’t know that it’s available or will run into problems finding out how to enroll. In late-September 2024, Healthy Men Inc. (HMI) conducted a short survey of prescription drug providers and participating pharmacies in the Medicare universe, and surprisingly found that none of them—yes, zero—had any information about the new benefit, even though open enrollment begins in mid-October. This is most alarming.

To help you and your eligible loved ones understand the new entitlement and determine whether it’s right for your circumstances, HMI has prepared this summary and compiled links to other important information sources. But most of all, we encourage you to call the provider you use for your Medicare-covered prescription drugs and ask for the information and specifically how to apply. Then do the math! If it is for you enroll. Take advantage of this new benefit program – it might not only help make prescription drug costs more manageable but also save some out-of-pocket costs.

What the New Plan is Structured to Do

• • • Cap Medicare total out-of-pocket costs for all drugs at $2000 per year, including copays and coinsurance.
    • Provide a “balanced-billing” type option to spread payment of all expected medication costs out through each year split into monthly payments;
    • Offer extra financial assistance with out-of-pocket medication costs through the “Extra Help” program option for qualifying beneficiaries.

What You Need to Do

Some of these changes, such as the yearly copay caps, are automatic. The others require enrollment.

Because of these changes, it’s really important to know that starting in January 2025, all Medicare plans will likely look a bit different in terms of what’s covered, at what levels they’re covered, and whether there are changes to medication access or authorizations. Because of the likely confusion, HMI urges all Medicare enrollees and their families to start looking now at how these changes will affect you. If your Medicare prescription drug management provider doesn’t have the information you need now, keep after them; you have a right to know and they have an obligation to tell you!

Where to Find Help

• CMS Resources: What’s the Medicare Prescription Payment Plan? | Medicare and Fact Sheet: Medicare Prescription Payment Plan (cms.gov)
• PAN Foundation: Understanding the Medicare Prescription Payment Plan – PAN Foundation
• Medicare Rights Center: Guidance on Inflation Reduction Act’s Medicare Prescription Payment Plan Released – Medicare Rights Center

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