Mrs. Hernandez is one of your clients. She has read that there is a new program that may help her manage prescription drug costs. What do you tell her about the Medicare Prescription Payment Plan?
a. Part D enrollees must opt into the Medicare Prescription Payment Plan at the beginning of the year.
b. Part D enrollees who choose to participate in the Medicare Prescription Payment Plan pay 25 percent of their drug costs at the point of service and the remainder during the rest of the plan year.
c. Opting into the Medicare Prescription Payment Plan will impact what counts toward their true out-of-pocket (TrOOP) colts.
d. Part D enrollees can opt into the Medicare Prescription Payment Plan at the beginning of the plan year or any point during the year
The correct answer and explanation is:
The correct answer is c. Opting into the Medicare Prescription Payment Plan will impact what counts toward their true out-of-pocket (TrOOP) costs.
Medicare beneficiaries enrolled in Part D have the option to participate in the Medicare Prescription Payment Plan (MPPP), a program designed to assist with prescription drug costs. When someone opts into the MPPP, the payments they make for prescriptions under the plan can impact their true out-of-pocket (TrOOP) costs. TrOOP refers to the total amount a beneficiary must pay out of their own pocket before reaching the catastrophic coverage phase of their Medicare Part D plan. This includes things like co-pays, deductibles, and payments made under the Medicare Prescription Payment Plan.
Participating in the MPPP can help lower the financial burden for beneficiaries by allowing some of the costs to count toward the TrOOP threshold, ultimately reducing out-of-pocket expenses over the course of the plan year. This plan doesn’t require the participant to opt in at the beginning of the year, and they can join at any point during the year. The goal of the MPPP is to make it easier for Part D enrollees to manage prescription costs, especially when they face high out-of-pocket expenses.
It’s important to note that options such as paying 25 percent at the point of service, as suggested in option b, aren’t part of the Medicare Prescription Payment Plan’s structure. Instead, the focus is on helping participants reduce their overall out-of-pocket spending by applying payments to TrOOP and easing the transition to catastrophic coverage.