By Annette Morrison, M.S., CRS-A/D, DCS, CCSI Case Coordination LLC
Jess groaned. At age 72, he was taking medications for high cholesterol, blood pressure, diabetes, depression, restless leg syndrome, and insomnia. He had insulin and ointments for psoriasis. By the time he was done swallowing his morning meds, he really had no room left for breakfast. To avoid stomach upset, he chewed his toast, sipped his coffee, and anticipated how much his drug plan deductible would set him back in January. Jess wasn’t broke – he had a modest retirement income from working with the Railroad for over 40 years, but the one-time payment of $540 to meet his deductible for his drug plan just to get his meds this January really put a damper on his budget. He thought about what he was willing to give up. He would likely have to forgo the weekly breakfast get-togethers with his friend group – The Romeos. Seeing as most of the guys were in the same situation, they would likely understand.
Jess will have another surprise in January 2025 – the Medicare Part D Deductible for most plans is going up to $590. There is some good news, though – the maximum True Out Of Pocket (TrOOP ) cost is dropping from 2024’s $8000 to $2000 in 2025 for medications covered on the drug plan’s formulary. Essentially, beneficiaries will go from Deductible, to Initial Coverage, to Catastrophic Coverage – eliminating the “Gap.” This means that once Jess’s drug costs add up to $2000, he will have no more copays so long as they are on the plan’s list of covered medications. This is exciting news for many Medicare beneficiaries who are taking high-cost medications – a potential savings of over $6000 in 2025.
A $590 deductible at the beginning of the year is a huge barrier for many beneficiaries. There is a silver lining in 2025. Medicare Prescription Drug Plan (PDP) and Medicare Advantage Plans with Prescription Drug Coverage (MAPD) companies are offering enrolled members a Medicare Prescription Payment Program (M3P) option. Instead of paying his deductible at the pharmacy in January 2025, Jess can choose to enroll in a M3P which will spread his costs out over the course of the year. Enrollment for the M3P happens with his Drug plan and is a separate payment than the plan’s premium. Once enrolled, Jess will pick up his medications at the pharmacy and pay nothing. Then he will get his M3P bill from the drug company he is enrolled in and pay them directly. Jess can choose to pay the deductible and his drug costs off early and exit the M3P. Or, if he doesn’t need his high-cost medication in January, he can sign up for the M3P mid-year, when he does need to meet his deductible. For older adults on a low, fixed income this is a more livable solution to massive costs in January.
Medicare Open Enrollment begins October 15th. By then, Medicare Prescription Drug Plan and MAPD companies are required to have their plan details updated on Medicare.gov. Beneficiaries will have until December 7th to compare plans and switch for 2025. Jess wanted to use the Medicare.gov website, but when he went on it last year he was overwhelmed by the sheer amount of information. So instead, he called CCSI Case Coordination and scheduled an Open Enrollment appointment with a Senior Health Insurance Program (SHIP) Counselor. His SHIP Counselor, Katie, helped him make an informed decision and took the time to print out coupons for medications that would still not be covered by his Medicare Prescription Drug Plan, saving him thousands4ss was confident that a CCSI SHIP Counselor could help him weigh the pros and cons of enrolling in the new Medicare Prescription Payment Plan to help ease the financial burden of a high deductible. He would definitely be encouraging his fellow Romeos to call CCSI!
To make your one-on-one appointment with a SHIP Counselor, contact CCSI Case Coordination LLC at 309-661-6400. We begin taking Open Enrollment appointments October 1st, 2024. We are located at 3601 G.E. Road, Suite 2, Bloomington, IL 61704. Services have no fee, but donations are graciously accepted. No one is ever denied assistance based on the inability to give. Funding is provided through ECIAAA and IDOA.