Medical Section – Prescription Drug Payment Program(called M3P) – Health Section Love Languages – there are 5

The Medicare Insurance Lady

Celebrating since 2008 as a Medicare Insurance Specialist

(This Is NOT A Government Newsletter)

📧 tcangemi@RetirementHPMS.com

MEDICARE SECTION

AEP – the Annual Enrollment Period (October 15^th to December 7^th). 

• If you change your Medicare insurance plan (with me) during AEP it would be effective January 1st, 2025. 
• October 1st agents/brokers can discuss the new 2025 plans with our Medicare eligible clients. We can enroll our clients starting October 15th.
• PLEASE REACH OUT AND CALL ME TO SCHEDULE YOUR REVIEW starting October 1st. All Enrollments will be scheduled after October 15th.

MEDICARE SECTION

MY COMMENTS to my clients:

I have been attending Agent/Broker trainings this last week for the 2025 Medicare insurance plans. 

WELL …. there will be a lot of changes for 2025 and you may not like them. It is due to the Inflation Reduction Act. 

As I understand it, this new Act is a progressive 3 year phase in. Bottomline, the insurance companies have explained that CMS (the government) is providing less money (or subsidies) to the insurance companies to operate their insurance plans. So, that get passed on to the members in the form of reducing benefits and may increase premiums and copays, etc. 

The GOOD NEWS if that the “Donut Hole” is going away (that $8,000 max out of pocket for Rx).  The total annual out of pocket for prescriptions for 2025 will now be $2,000. Insulin will be no more than a $35 copay per 30 days.

I CAN PUT TOGETHER A GROUP ZOOM WEBINAR TO DISCUSS THE CHANGES IN 2025 ONLY, NOT SPECIFICALLY THE BENEFITS OFFERED WITH EACH INSURANCE PLAN AND CARRIER. I would have to discuss plan benefits and changes individually.

PLEASE TEXT ME (315.727.4933) IF ANYONE THINKS THIS WILL BE VALUABLE TO HEAR AN OVERVIEW OF WHAT TO EXPECT FOR THE 2025 PLAN YEAR. 

This would be more like a group Zoom discussion then followed by a question and answer opportunity. 

MEDICARE SECTION

NEW – PRESCRIPTION DRUG PAYMENT PROGRAM (called M3P)

There are lots of changes coming up in 2025. 

One of them is part of the Inflation Reduction Act (referred to as the M3P): Medicare Prescription Payment Plan

For the first time, beginning in 2025, the prescription drug law, known as the Inflation Reduction Act, requires all Medicare prescription drug plans (Part D plans) — including both standalone Medicare prescription drug plans and Medicare Advantage plans with prescription drug coverage — to offer enrollees the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments instead of all at once at the pharmacy.

Part D Improvements

People with Medicare will benefit from lower prescription drug costs and a redesigned prescription drug program. Benefits include:

• Insulin available at $35/month per covered prescription
• Access to recommended adult vaccines without cost-sharing
• A yearly cap ($2,000 in 2025) on out-of-pocket prescription drug costs in Medicare, reduced from $8,000 (in 2024)
• Expansion of the low-income subsidy program (LIS or “Extra Help”) under Medicare Part D to 150% of the federal poverty level starting in 2024 – to help more Medicare recipients save on the cost of their prescription drugs.

(we are told that NY State does not consider resources for qualification. Please ask when applying for Extra Help to confirm this).

What is the Medicare Prescription Payment Plan?   

The Medicare Prescription Payment Plan is a new program created under the Inflation Reduction Act that requires Part D plan sponsors to provide their enrollees with the option to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year instead of all at once to the pharmacy.

The program begins January 1, 2025. Program participants will pay $0 to the pharmacy for covered Part D drugs, and Part D plan sponsors (your prescription plan company) will then bill program participants (you) monthly for any cost sharing they incur while in the program. Pharmacies will be paid in full by the Part D sponsor (your prescription plan company) in accordance with Part D prompt payment requirements.

• Starting with plan year 2025, any current Part D enrollee may opt into the program prior to the beginning of a plan year or in any month during a plan year.
• Part D plan sponsors (your prescription plan company) must have a process in place to allow their program participants to opt out at any point during the plan year. Part D plan sponsors will continue to send monthly bills if someone opts out of the payment plan.
• You will be billed from your prescription plan for your premium and billed separately for the prescription drug payment plan (copay costs).
• The law requires Part D sponsors to notify the pharmacy when one of their Part D enrollees incurs out-of-pocket costs for covered Part D drugs that make it likely the individual may benefit from the program. If a Part D enrollee has cost sharing for a single covered Part D drug of $600 or more and has not already opted into the program, the Part D sponsor (your insurance company) will be required to notify the pharmacy to inform the individual about the program.
• Likely candidate is someone who would spend $600 at the pharmacy (POS threshold) based on a single prescription.
• Likely candidate is someone who spends $2,000 in prescription costs annually.
• Unlikely candidate is someone who has the same prescription costs monthly.
• Unlikely candidate is someone who joins the program after September.
• Unlikely candidate is someone who receives Extra Help (from the government) with their prescription drug costs
• For Existing Members – you will hear about and get more information in the ANOC – Annual Notification of Change document mailed out by the end of September by each carrier or insurance company. Also in your monthly EOB – Explanation of Benefits mailings.
• For New Members – will receive information with your enrollment ID Card Kit or Welcome Kit, after enrollment in a plan.
• Existing Members can opt into a payment plan any time after October 15^th.
• Existing Members can opt into a payment plan by calling the Member Services number on the back of your insurance card or online with your plan website.
• When enrolling into a Medicare Advantage or prescription drug plan, there will not be an option to enroll in a payment plan at that time.
• If choosing to enroll in the payment plan, the payments are divided up over 12 months. If you pick up other medications during the year payments may increase.
• What happens if you don’t pay your bill? You will be removed from the payment program only, not your prescription plan. There will be a 60 day grace period if you don’t pay by the due date.
• Finally, the payment program is voluntary and there is no cost to participate AND the program does not save you money or lower your drug costs.

HEALTH SECTION

LOVE LANGUAGES – there are 5

Pastor Gary Chapman created The Five Love Language theory that says people express love through words of affirmation, physical touch, qualify time, acts of service or giving gifts to have a successful relationship.

 I LOVE this “theory” from Pastor Chapman and I think if we look at our relationships in this “Love Language” way, it helps us to better understand what each of us needs from our relationships and to get along.

“Chapman suggests that to discover another person’s love language, one must observe the way they express love to others, and analyze what they complain about most often and what they request from their significant other most often. He theorizes that people tend to naturally give love in the way that they prefer to receive love, and better communication between couples can be accomplished when one can demonstrate caring to the other person in the love language the recipient understands.

An example would be: if a husband’s love language is acts of service, he may be confused when he does the laundry and his wife does not perceive that as an act of love, viewing it as simply performing household duties, because the love language she comprehends is words of affirmation (verbal affirmation that he loves her).

She may try to use what she values, words of affirmation, to express her love to him, which he would not value as much as she does. If she understands his love language and mows the lawn for him, he perceives it in his love language as an act of expressing her love for him; likewise, if he tells her he loves her, she values that as an act of love.”

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