Medicare Updates: Part D and Deferring Enrollment Past 65


From the ACE TA Center Listserv - 6/27/24

Changes ahead for Medicare Part D

There are several big changes ahead for Medicare Part D beneficiaries, and RWHAP recipients may want to start planning for how they will communicate these changes to clients.

  1. Starting in January 2025, there will be a new $2,000 annual out-of-pocket maximum on how much Medicare Part D beneficiaries will have to pay in cost sharing (deductible and coinsurance) for their medications every year. This could be a big cost savings for people with HIV and other comorbidities who need high-cost medications to stay healthy. 
  2. Also going into effect in 2025 is the availability of the Medicare Prescription Payment Plan (MPPP). The MPPP is an optional program that allows beneficiaries with high Medicare Part D cost sharing to “smooth” their cost sharing through even payments over the course of a plan year rather than pay a high amount in the beginning of the year to meet their plan’s deductible. The program is geared toward individuals on very high-cost drugs who would anticipate hitting their $2,000 annual out-of-pocket maximum very early in the plan year. 

In anticipation of the implementation of the MPPP, CMS is developing consumer outreach and education materials that will be released this summer. The ACE TA Center will develop MPPP resources specific for RWHAP staff and clients, as well. Stay tuned for much more information in the coming months.

Medicare Tip of the Month

Still working after 65 and deferring Medicare enrollment?

Many clients who are still working past age 65 and continue to receive employer-sponsored insurance* enroll into premium-free Medicare Part A while deferring enrollment into Medicare Parts B and D. However, clients should take the following steps before deferring enrollment into one or more Medicare Parts:

  1. Check with your employer's human resources department to confirm if the coverage they offer is at least as good as Medicare's coverage, and
  2. Contact the Social Security Administration to confirm if deferring one or more Medicare Parts would incur a late enrollment penalty

*Note: Retiree plans and COBRA are not considered qualifying coverage and would not exempt clients from a late enrollment penalty. 

We'd like your feedback

Was this page helpful?
I found this page helpful because the content on the page:
Check all that apply
I did not find this page helpful because the content on the page:
Check all that apply
Please include an email address if you would like a response
Please include an email address if you would like a response
Did you use this approach in your work?
Not yet because
If no, why not?