Medicare Part D Benefit Redesigned

Beginning Jan. 1, 2025 – Part D maximum out of pocket capped at $2,000

What does this mean? It caps the most you will pay out of pocket for covered prescriptions at $2,000, and the coverage gap (“donut hole”) will be eliminated.

How does it work? The newly defined standard Part D benefit consists of three parts. See what you pay with IU Health Plans coverage:

*If you receive Medicaid or Extra Help, your initial coverage costs will be reduced.

NEW – Optional Participation Medicare Prescription Payment Plan 
If you find your medications expensive and difficult to pay for a monthly supply, the new Medicare Prescription Payment Plan may help you manage drug costs by spreading payments out across the year (January – December). This plan does not change the plan you are enrolled in, prescription drug costs or the cap on what you will pay in a year. You won’t pay any copays or coinsurance directly to your pharmacy; instead, you’ll get a bill each month from IU Health Plans. This program is not a good fit for everyone, including people who have drug costs that average less than $200 per month, those receiving Medicaid or Extra Help from Medicare, or individuals who may qualify for a Medicare Savings Program.

How will Medicare Prescription Payment Plan work? 

1. Elect to participate in the Medicare Prescription Payment Plan by completing the necessary electronic form available at Caremark.com; You can also call 1.844.432.0695, 24 hours a day, seven days a week. TTY: 711. It is recommended that you read more about this plan before signing up for it. 
2. Fill a prescription for a Part D-covered drug. 
3. Don’t pay the copays or coinsurance directly to the pharmacy. 
4. Receive a monthly bill from IU Health Plans based on the amount you owe for any prescriptions you receive, plus what you still owe from a previous month (incurred and accumulated balance), divided by the number of months left in the year. 
5. There's no cost to participate in the Medicare Prescription Payment Plan. 

Note: Urgent requests for the Medicare Prescription Payment Plan can be made under certain circumstances. If you face an urgent need due to financial hardship or unexpected medical expenses call 1.844.432.0695, 24 hours a day, seven days a week. TTY: 711.

For more information please review the Medicare Prescription Payment Plan fact sheet or visit Medicare.gov. 

CVS Caremark also created this video overview about Medicare Prescription Payment Plan. It's also available in Spanish. 

If you have an issue with the Medicare Prescription payment plan, please follow our standard complaints or grievances procedure. This information is also available in your Evidence of Coverage document, Section 3. 

What's Extra Help?

"Extra Help" is a Medicare program to help people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance and other costs. You also won't have to pay a Part D late enrollment penalty while you get Extra Help.

Some people qualify for Extra Help automatically, and other people have to apply. For those that qualify, Extra Help would likely be more beneficial than the Medicare Prescription Payment Plan. For more information, please visit the Medicare.gov web page about Extra Help. 

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