Are You Experienceing Issues with Medicare Prescription Payment Plans on Medicare.gov?

Be wary that Medicare.gov’s Plan Finder might experience difficulties when it comes to showing costs related to… [+] the Medicare Prescription Payment Plan.getty
The Medicare Prescription Payment Plan, also referred to as MPPP, MP3 or M3P is an exciting new program set to go into effect January 1st 2025 – coinciding with a $2,000 cap on out-of-pocket drug costs on Part D plans. Like an installment payment plan for those covered by prescription drug plans such as Part D’s. Members will have more control of how costs are spread out throughout the year as opposed to having all costs hit all at once.

Here are a few facts about the MPPP:

Anyone enrolled in Part D drug coverage through either an independent plan or Medicare Advantage will qualify for this program, though only drugs listed on your plan’s formulary qualify for inclusion. Once enrolled in this plan there may be monthly bills associated with participation.
The cost can depend on several variables, including whether a plan has a deductible and which medications an enrollee takes, among other considerations. While MPPP will help spread out costs across enrollees more evenly than an insurance plan would do on its own, no savings should be expected by enrolling; $2,000 remains maximum spendable limit with regards to covered medications under its coverage and MPPP simply spreads them across enrollees more easily.
Participation in this program is completely voluntary; enrollees can decide for or against joining, prompting many people to ponder if joining is right for them. Many may ask themselves “Should I sign up or not?”

Medicare Plan Finder now features 2025 drug plan details as well as MPPP information and charts demonstrating potential costs with or without this payment option.

Prior to the section titled, “Estimated Total Drug and Premium Cost,” there is an informational paragraph regarding Medicare Prescription Payment Plans. By clicking “Find out what your drug costs might look like with this payment option” you will open another box, “How will My Monthly Bill Be Calculated? Given costs can differ by pharmacy, save, create PDF or screen capture each chart you selected (using pulldown menu and “Change.”) As costs will depend upon pharmacy location (locate each pharmacy name with click “Change.”) for each chart (locate each pharmacy name by pulldown menu then clicking, “Find out what drug costs might look like” then appear “Find out what your drug costs might look like with This payment option”. To open that box click, “Find Out what Your drug Costs Might Look Like With This Payment Option”. A box then appears with instructions “Find Out what Your Cost Might Look Like With This Payment Option.” Once in that box to see “What will My Monthly Bill Be Calculated”. To create PDF or screen capture the chart save, create PDF from each pharmacy name then clicking, Change) for every pharmacy from “Change”. To switch “Change”, or screen capture each chart separately). To change “Change”, find that pharmacy name from pull down menu select, “Change”, but do note you can change”.)”).

Noted in the chart is explanatory text which serves to remind users: This table only includes costs related to covered medications; any unreimbursed costs won’t appear here.” Additionally, keep in mind that this chart serves only as an estimate based on current drug regimen – any changes throughout the year could alter monthly amounts significantly.

Three Good Examples and One Major Concern The chart includes two columns; monthly costs without enrollment in any program vs enrolled costs vs those which result from enrollment; along with four examples which likely reflect more typical situations.

This first example illustrates an all too typical scenario; those who will fall below the $2,000 cap. Without an MPPP plan in place, these individuals would pay their share when purchasing medications each month; with it in place however, payments range anywhere from $3.38 to over $111.33 on an ongoing monthly basis.

Example 2Diane Omdahl The second example shows what would happen for someone enrolled who takes five drugs, including at least one Tier 4. They would reach the $2,000 cap within one month unless they sign up with MPPP – otherwise their premium payments will increase every month through 2019. Exhibit 2.Diane Omdahl
Example 3Diane Omdahl presents another scenario involving two Tier 3 medications and mail order as his preferred delivery option. Without enrolling in MPPP, his expenses in January will total $1564.82 with costs rising up to $435.18 by April. If enrolling instead in MPPP will cut monthly costs to around $127-11 or so per month compared with paying upfront fees upfront for these items (Figure 5).
The fourth example outlines costs associated with 10 drugs from Tiers 2 and 3. As indicated by the chart, an individual taking 10 Tier 2 and Tier 3 medications could face monthly costs totaling almost $3,200 without participating in MPPP; by enrolling, his costs would drop dramatically; totaling only $166.67 monthly saving in calendar year costs!
What gives? His selected pharmacy was out-of-network and since drug plans do not cover noncontracted pharmacies, this enrollee would have had to bear all costs (approx. $38,286.12) himself without receiving any savings through their MPPP plan. Someone needs to fix the calculation to account for costs from out-of-network pharmacies (See Example 4 by Diane Omdahl for further explanation of her calculations.). Example 4. Diane Omdahl
In Example 5, Diane Omdahl shows how switching to an in-network pharmacy could save him money without incurring cost savings; his costs would depend on whether or not they enrolled in MPPP; either option result in monthly costs ranging between $620-$2,002. Neither column contains cost savings – they all add up to an equal total amount:
Should You Enroll? Individuals who fail to reach the cap (example 1) likely won’t enroll as their monthly costs become unpredictable and unpredictable payments come due.
Example 2 and 3 illustrate enrollees paying $2,000 over 12 payments instead. If possible, that might be less of an inconvenience; those with limited resources might opt for smaller monthly payments instead.
As seen in Example 5, cases where it takes longer than two months to hit their $2,000 cap may require making different choices about when payments should occur; one option could include making payments immediately at medication pick up rather than waiting for billing statements from their providers; either option should keep this important reminder in mind:

Maximum payment out-of-pocket limit per pharmacy within an MPPP network: $2,000. No savings to be had here – so only participate if there is benefit; disenroll from it at any time if desired.
Pay special attention during the Open Enrollment Period!