Medicare Changes in Motion: Early Experiences and Key Insights

Beginning January 2025, Medicare Part D beneficiaries have the option to enroll in the Medicare Prescription Payment Plan (M3P)- a key change under the Inflation Reduction Act. While M3P is an option intended to help people better manage the out-of-pocket costs of their medicines over the course of the year, there are clear opportunities for improvement based on the early stages of the rollout.  

 In part 3 of a series on Medicare Part D changes, Accessia Health welcomed back William Sarraille JD, Founder of Saraille and Associates as well as Laura Cave, Chief Brand Officer at Paytient and Melissa Paige, President & Co-CEO of the National Association of Medication Access & Patient Advocacy (NAMAPA) & Healthcare Advocate Summit to offer their firsthand, expert insight on what is happening with M3P and how to navigate enrollment obstacles and improve awareness and education.  

 

Review of the $2,000 Cap on Out-of-Pocket Expenses for Medicare Part D

As we covered in parts 1 and 2 of the webinar series, starting on January 1, 2025, there is a $2,000 cap on out-of-pocket (OOP) expenses for Medicare Part D (including part D coverage included with most Medicare advantage plans). There is no need to take action to receive this benefit—it is automatically applied by Medicare plans. 

Overview of the Medicare Prescription Payment Plan “Smoothing Benefit”  

The M3P, also called the smoothing benefit, is a voluntary option that Medicare beneficiaries may opt in to that will spread or smooth the OOP costs of their prescription medications over the course of 12 months—rather than paying the full amount at the beginning of the year.  

What to know about M3P:  

  • How to opt-in: Beneficiaries must proactively contact their Part D Plan sponsor (or Medicare advantage plan sponsor if part D coverage is included) and opt-in either via a toll-free telephone number, website, or traditional mail.  
  • Who may benefit The option is expected to be particularly beneficial for those with $600+ in medication costs but is open to all Part D beneficiaries.  
  • Who may not benefit: Beneficiaries who qualify for the Low-Income Subsidy (LIS) already have little to no copays and should review this benefit carefully to determine if it is the best option.  

Current Challenges for M3P Implementation  

Initial data from an ongoing Accessia Health survey found that there are obstacles to enrollment in M3P and opportunities to improve education about the program and the enrollment process. Among participants surveyed so far:  

  • 33% had OOP costs over $2,000 and of those, only 18% are enrolled in M3P.   
  • 96% have a rare or chronic health condition but only 23% are enrolled in M3P.  

Trends that have emerged as key challenges facing the rollout:   

  • Low awareness and confusion: Many beneficiaries are unaware of M3P, unsure whether they would benefit from enrolling, or have mistaken it as a separate prescription drug plan or benefit, rather than an option for smoothing out their OOP costs.  
  • Confusion at the pharmacy: Pharmacists are generally not well-versed in the option yet, unsure how to process claims for beneficiaries enrolled in M3P, or in some cases are incorrectly processing claims.  
  • Complex opt-in process: Beneficiaries are experiencing long wait times to complete the enrollment process by phone, and without the option to enroll at the pharmacy counter, there is no “real-time” enrollment option right now.  

Solutions to Improve Understanding of M3P and the Enrollment Process  

Panelists also signaled several solutions to help navigate and resolve the current challenges of enrollment:  

  • Better education, particularly for vulnerable populations: Clearer and more frequent resource-sharing and communications from Medicare and at the pharmacy counter will be necessary to increase enrollment. This is especially true for chronically ill, lower-income beneficiaries who are most likely to benefit from M3P, but because of health literacy barriers, are less likely to understand the benefits of enrollment.  
  • Earlier notification of M3P in the patient care journey: Beneficiaries should be notified of the M3P option as soon as a higher-cost medicine is approved for coverage—either by their healthcare provider or pharmacy. This proactive notification would allow patients to enroll before arriving at the pharmacy, ensuring their claim can be processed smoothly and without delay.  
  • New enrollment platform: Paytient has developed a new tool for M3P called Getmymeds.com— a convenient, free, and secure platform that helps people understand and opt in to the program. Paytient is in the process of getting the platform assimilated into healthcare provider and pharmacy workflows for even easier enrollment.  

As we’ve seen, the Medicare Prescription Payment Plan has the potential to make a real difference for many Medicare Part D beneficiaries, especially those facing high medication costs. But early insights show that getting the word out and making enrollment easier are just as important as the benefit itself. With better education, more timely communication, and new tools for beneficiaries, we’re heading in the right direction. There’s still work to be done, but with continued collaboration and advocacy, we can help ensure that M3P lives up to its promise. Accessia Health remains dedicated to guiding patients, caregivers, and healthcare professionals through these changes and will continue to share updates and resources as the program matures.