Janell Sluga Medicare & Individual Health Insurance Account Executive View Bio

Lawley Medicare Solutions Learning Center:

Ask Janell!

QUESTION: I received a Medicare Prescription Payment Plan form from my insurance company. Am I supposed to sign up for this?

ANSWER:  The Medicare Prescription Payment Plan (M3P) is a new option for individuals with Medicare Part D coverage. This option is designed to help those with high prescription drug costs by allowing you to spread the cost of medications across the entire year. You may see it referred to as M3P in some documents.

If you complete this form and return it to your insurance company, you will not need to pay for your medications upfront when you visit the pharmacy. Instead, you will receive a monthly bill from your insurance company, which will spread the costs across the remainder of the year.

The M3P option is intended for individuals with very high prescription drug costs. For those whose medications cost thousands of dollars each month, the out-of-pocket expenses at the beginning of the year can be significant. Most Medicare Part D plans have a deductible, which requires you to pay full price for your medications until the deductible is met. The deductible can range from $200 to as high as $590. Once the deductible is paid, you enter the Initial Coverage phase, where medications are covered with a copay, which can vary. Copays might be a fixed amount (e.g., $0, $5, or $42) or a percentage (e.g., 25%, 33%, or 40%).

If you’re considering using the M3P to spread out the cost of the deductible, keep in mind that as you continue to fill prescriptions throughout the year, those costs will be added to your monthly payment. For example, if your deductible is $590, spreading it out over 12 months means an additional $49.16 per month. If you continue to fill a medication that costs $42 per month for the remainder of the year, your monthly payment will increase. In this case, by February, your monthly payment would rise to $52.98, and by March, it would be $57.18, continuing to grow as the year progresses.

If you only have a standard deductible and regular copays throughout the year, the M3P might not be the best choice for you. It is most beneficial for individuals with very high medication costs, especially those who quickly reach the Maximum Out-of-Pocket (MOOP) limit of $2,000.

For example, if your first medication copay is $1,479, the M3P option would spread that cost over 12 months, resulting in a monthly payment of $123.25. In February, if your next medication copay is $521, your payment for the month would increase to $170.61. From February to December, this amount would stay the same, as you would have already reached your $2,000 MOOP for the year. This structure allows you to spread out large costs without facing interest charges, unlike using a credit card.

In the past, many people with high prescription costs had to use credit cards to cover their medication bills, resulting in high interest charges. The M3P option eliminates that concern and helps individuals manage their medication costs more easily.

While I believe the M3P option will be a great help to individuals with extremely high medication costs, it’s important to remember that it’s not for everyone. When reviewing your coverage for 2025, consider your expected copays and how they accumulate throughout the year. If you will reach the $2,000 MOOP early in the year, the M3P is likely a good option for you. However, for most people who only have regular copays, you likely don’t need to sign up for the M3P.

So, unless you fall into the group that would benefit from spreading out high medication costs, do not complete the Medicare Prescription Payment Plan Participation Request form. Simply keep it for your records or recycle it if you don’t need the plan.

If you have questions or need assistance navigating your options, don’t hesitate to reach out to the Lawley Medicare Solutions Team. You can contact Medicare Service Team Lead Gabrielle Connor at 716.849.8223, or submit an inquiry through our contact form below. We’re here to help you find the right coverage for your needs!

At Lawley Medicare Solutions, our Medicare and Individual Health Consultants are dedicated to helping you make the most informed decisions about your healthcare needs. We offer personalized service and expert advice tailored to your unique situation. Contact us today by phone or email to schedule a consultation and ensure you’re getting the best coverage for your needs.

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Our licensed Medicare & Individual Health Insurance team can help clients understand the details of Medicare insurance plans, assist with choosing the right benefits and coverage, and provide guidance when life events that affect health coverage occur.

For questions, concerns, or to reach Lawley Medicare Solutions, call 716.849.8223.