• Do you have any victories you'd like to share for the month of May? Help us celebrate others by posting here.

How will part D smoothing of payments work ?

DonP

Guru
1000 Post Club
4,415
I understand you can set the equal payments up front? So is there a criteria for this ? Do there part D costs have to be the max $2000 troop up front to qualify ? What if someone sets up Jan 1st during aep and switches plans April 1st during oep ? Does the carrier transfer the “ smoothing “ to the new carrier ?
 
I understand you can set the equal payments up front? So is there a criteria for this ? Do there part D costs have to be the max $2000 troop up front to qualify ? What if someone sets up Jan 1st during aep and switches plans April 1st during oep ? Does the carrier transfer the “ smoothing “ to the new carrier ?

It is the 600.00 threshold that initiates the rx financing i believe


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 will be required to notify the pharmacy to inform the individual about the program.The pharmacy will provide the Part D enrollee with the Medicare Prescription Payment Plan Likely to Benefit Notice, a standardized notice that all Part D sponsors are required to use

Starting with plan year 2025, any 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 enrollees or their legal representative will be able to opt in directly with their Part D plan sponsor via several different mechanisms. When Part D sponsors receive a request to opt into the program before the plan year begins, they must process the request within 10 calendar days of receipt. When a request is received during the plan year,they must process it within 24 hours of receipt.Although real-time/POS election will not be required in 2025, CMS is committed to exploring real-time/POSelection mechanisms that can be implemented for future year





 
So, who ends up taking the initial hit. The insurer or the pharmacy? Who does client pay monthly payments too? Insurer or pharmacy?
 
There is no minimum Rx amount; anyone can enroll into the Medicare Prescription Payment Plan (CMS dropped the "smoothing" name a while ago). When I mean anyone, I mean anyone -- including those with Medicaid/Extra Help.

Clients will pay the carriers back. If someone changes carriers mid-year, the Rx balance does not transfer. The carrier can request a lump sum payment, but must still accept monthly payments through the remainder of the year.
 
There is no minimum Rx amount; anyone can enroll into the Medicare Prescription Payment Plan (CMS dropped the "smoothing" name a while ago). When I mean anyone, I mean anyone -- including those with Medicaid/Extra Help.

Clients will pay the carriers back. If someone changes carriers mid-year, the Rx balance does not transfer. The carrier can request a lump sum payment, but must still accept monthly payments through the remainder of the year.

So if someone has an unpaid balance with a carrier and they switch plans but then wants to come to original carrier that unpaid balance may have to be repaid for them to re enroll sort of how some plans now demand unpaid premiums be paid back .
 
There is no minimum Rx amount; anyone can enroll into the Medicare Prescription Payment Plan (CMS dropped the "smoothing" name a while ago). When I mean anyone, I mean anyone -- including those with Medicaid/Extra Help.

Clients will pay the carriers back. If someone changes carriers mid-year, the Rx balance does not transfer. The carrier can request a lump sum payment, but must still accept monthly payments through the remainder of the year.

I wonder what happens if the balance isn't paid? Goes into collections? Or is there something more serious?
 
I wonder what happens if the balance isn't paid? Goes into collections? Or is there something more serious?
probably not they just get blackballed from carrier they owe money to until they pay up- this will be a lot of fun if they really let LIS members financing their piddling copays
 
All I see is consumers getting more in debt. As more meds are prescribed, balance only gets bigger, year after year.

And more pdp carriers leaving. Who wants to give interest free loans out and incur administration costs?
 
Back
Top