Frequently Asked Questions – Upcoming Changes to Medicare
We recently hosted a two-part webinar series focused on the Inflation Reduction Act and its impact on Medicare. The sessions sparked meaningful conversations, with participants asking insightful questions about the upcoming changes. To keep the conversation going, we’ve compiled a comprehensive list of the most frequently asked questions along with clear, helpful answers.
WATCH SERIES ON DEMAND HERE
Does the $2000 cap apply to brand and generic medications?
Yes, the cap applies to all medications that are covered by your Medicare prescription plan.
What drugs are not included in the $2000 cap?
Drugs not covered by the plan and drugs that are covered under the medical benefits.
Does the cap apply to the drug coverage included in a Medicare advantage plan?
Yes, the cap applies to all Medicare prescription drug plans including standalone part D plans and Medicare Advantage plans with drug coverage.
Are there any tools to determine if the Medicare prescription payment plan is the right option for me?
Medicare has published an M3P tool located here: https://www.medicare.gov/prescription-payment-plan/will-this-help-me
If I opt in to the Medicare prescription payment plan, how will I know the amount of my monthly payment?
The amount you will pay varies depending on the drugs you take, month you opt in, and months you have remaining in the year.
How do you opt in to or out of the Medicare prescription payment plan?
You can opt in or out of the Medicare prescription payment plan any time during the year by contacting your Part D or Medicare Advantage plan.
Once I opt in to the Medicare prescription payment plan, who do I make payments to?
You will receive a monthly bill from your Medicare prescription plan and will make payments directly to the plan.
Can you opt in to the Medicare prescription payment plan at the pharmacy?
No, you will need to contact your Medicare prescription plan to enroll.
Do you have to opt in to the payment plan every year?
Yes, you will have to opt in each year if you want to continue participating.
What if I opt in to the Medicare prescription payment plan but fail to make the payments?
Participation in the program may be terminated following a required two-month grace period.
Can you opt in to the payment plan for only one medication?
No, the payment plan applies to all medications covered by your Medicare prescription plan.
If I learn at the pharmacy my medication is unaffordable and I call my plan to opt in to the Medicare prescription payment plan, how long until I receive the medication?
Medicare prescription plans must process the payment plan request within 24 hours of receipt during the plan year.
If I receive assistance from a patient assistance organization, will I be required to opt in to the payment plan?
It depends on the requirements of the patient assistance organization. Accessia Health does not require individuals to participate in the payment plan.