Question: I got a Medicare Prescription Payment Plan form from my insurance company, am I supposed to signing up for this?

Answer: The Medicare Prescription Payment Plan is a brand new option for those with Medicare Part D coverage. We call this option the M3P, so you may see it referred to as that. The M3P option allows you to spread out the high cost of your medications across the entire year of 2025.

If you complete this form and mail it back to your Insurance Company, when you go to the pharmacy you will not have to pay for your medication and will instead receive a monthly bill from your insurance company which will spread the costs across the remainder of the year.

This M3P was designed for those individuals who have VERY high prescription drug costs. For those individuals whose medication costs thousands of dollars a month, their cost share in January can be significant.

All of those individuals with Medicare Part D likely have a deductible which requires them to pay full price for their medications at the beginning of the year. This deductible could be $200 or it could be as high as $590. Once you have paid the deductible you step into the Initial Coverage phase and your medications have a copay of some amount, sometimes a set dollar figure, like $0, or $5, or $42. Sometimes the copay is a percentage like 25%, or 33% or 40%.

If you are thinking about using the M3P to spread out the cost of the deductible, remember that as you continue to fill medications throughout the year, those costs will continue to be added to that monthly payment. So imagine a $590 deductible spread across the 12 months, that becomes $49.16 per month. If you continue to fill a medication at $42 per month for the remainder of the year, the M3P payment would continue to get bigger and bigger as the year progresses. ($42/11=3.82, $42/10=4.20, $42/9=$4.67, and on and on.) So your January payment would be $49.16. Your February payment would be $$49.16+$3.82=$52.98. Your March payment would be $57.18. Your April payment would be $61.85. You can see how that would add up each month as you went through the year and that is for just ONE medication. Imagine all of your copays adding up all year. It would make the end of the year the most expensive month.

So for those individuals who have a deductible to meet and then regular copays throughout the year the M3P is probably NOT something you want to enroll in. The M3P is designed for those individuals who medications costs thousands of dollars and the first month or so they hit the Maximum Out Of Pocket (MOOP) of $2000 right away.

I see a number of clients who have this impact them pretty significantly in January and February. In this situation the M3P does as it was designed to do, spread out those significant costs throughout the year in a regularly payment.

To illustrate, if the first time you fill your medication, you copay is $1479, your M3P benefit would spread out that cost to a monthly payment of $123.25 over the 12 months. In February you go back to the pharmacy and your medication costs $521 and then all your medication is $0 for the rest of the year because you have met your $2000 MOOP. In this situation the January payment would be $123.25. Then in February you add on the $521/11 which becomes $47.36. So from February to December your payment becomes $170.61. The payment doesn’t increase as the year progresses because you have already met the MOOP of $2000. You have spread out that $2000 over the twelve months of the year at no additional cost to you.

In the past the only way to spread out that cost was to use a credit card and then you have monthly interest added to the payment. I saw many individuals on Medicare with significant balances on their credit cards because they were trying to pay for their medications and couldn’t afford to pay that large payment all at one time.

I am really excited about the M3P Option and feel that it will help a lot of individuals with VERY expensive medication. But like all things Medicare this option is NOT for everyone! When evaluating your coverage for 2025, look at your copays and how they add up during the year. If in the first quarter of the year you meet the $2000 MOOP, the M3P is for you. For the rest of us, we just need to pay for the copays as they happen throughout the year.

So don’t complete the Medicare Prescription Payment Plan Participation request form unless you fall into that small portion of the population who needs it. If you don’t need to spread out those costs, don’t complete the form, just put it in your files or recycle the paper if you wish.

Janell Sluga is a Geriatric Care Manager helping seniors in our community access services and insurance. To reach her, please email editorial@post-journal.com.