Important changes are coming to the Medicare program that will make prescription drugs more affordable for Medicare Part D enrollees and the family members who help manage their care. The good news is that all Medicare Part D enrollees will automatically receive a cap on out-of-pocket costs, covering all prescription drugs, copays, and co-insurance related to Part D medications. For family caregivers, this means more predictable costs and fewer worries about unexpected medication expenses.
In addition, the Extra Help program is expanding to provide more financial assistance for families with limited income or resources. This program supports individuals who are on Medicaid, receive support for Part B Medicare premiums (such as through a Medicare Savings Program), or receive Supplemental Security Income (SSI). As a family caregiver, you don’t need to take any special steps to ensure your loved one receives the new cost cap protection – it will happen automatically.
Medicare will also offer an option to “smooth” healthcare costs related to Part D medications. Rather than paying at the pharmacy counter, Medicare beneficiaries can opt to pay a level amount throughout the year as part of their monthly bill. Importantly, enrollees must elect this option during the Open Enrollment period this fall.
While smoothing won’t lower the cost of medicine, it can help address uncertainty that can sometimes make paying for medicine more difficult for families by leveling the annual cost into equal monthly payments. There are some restrictions and guidelines that families should carefully evaluate. (The Alliance for Aging Research, an NAC member, has an excellent guide to pitfalls to avoid here.)
The new program, coined the “Medicare Prescription Payment Plan,” is part of the Inflation Reduction Act passed under the Biden-Harris Administration. It is intended to improve the affordability of prescription drugs. The program enjoys widespread support from patient advocacy organizations and trade partners alike. The trade association PhRMA called for CMS to develop education and outreach tools in the rollout, noting broad bipartisan support for tools such as cost smoothing in its March 2023 letter.
Medicare Open Enrollment has already begun and will last through December 7. To share information about these new programs, check out these fantastic resources.
- The National Health Council has an explainer video and social media kits about the upcoming changes, as well as additional links to patient advocacy organizations, such as the Lupus Foundation of America, which has developed disease-specific resources.
- The Alliance for Aging Research’s Project Loop offers essential reminders about how the program works and caveats for families to consider.
- Policy wonks will appreciate the Medicare Rights Center’s breakdown of the Medicare Prescription Payment Plan here.
