Prescription costs for people enrolled in Medicare will soon be capped

AUSTIN, Texas - Prescription costs will soon be capped for people on Medicare. There will be a new program, so you won't have to pay thousands of dollars up front. 

Sylvia Gordon, also known as the Medicare Mama, joined FOX 7 Austin's Rebecca Thomas to answer questions about Medicare, Social Security and retirement in general for almost a million followers across social media.

REBECCA: Sylvia, what is this new Medicare prescription drug program, and how much will people pay?

SYLVIA: The maximum that anyone on a Medicare drug program will pay. Starting in January 2025, it is $2,000 out of pocket. So in the past or this year, right now, the most you could pay would be about $8,000. So people that take a lot of drugs are really looking forward to this new law going into effect.

REBECCA: What happens if people are unaware that a pharmacy will step in to help? How do you get signed up?  

SYLVIA: So there are two separate parts. The cap is a maximum of 2000 out-of-pocket, and they're going to allow you to spread that 2000 that you pay out over the whole year. That's called the M3P. And it stands for Medicare Prescription Payment Plan. It's a mouthful. So, so let's say I go to the pharmacy in January and my prescription is $2,000. Makes it very simple. I will pay zero at the pharmacy. I will go to the pharmacy and not pay anything because I'm enrolled in this M3P plan with my drug company. Then the insurance company will send me a bill for 1/12 of the cost of my drugs every month. So I'll pay $167 a month to my drug company. And I didn't pay anything at the pharmacy. 

REBECCA: Now. What challenges have Medicare patients experienced in the past, and why was the new prescription drug program created? 

SYLVIA: So a small amount of people had to pay. Like, for example, this year, $8,000 out of pocket. People really struggled to come up with that. Many people skipped dosages or didn't take their medication at all because they couldn't afford it. So the Inflation Reduction Act is capping the out-of-pocket, which will greatly help people, but only a few people. Everybody else is going to pay for the feel that it will help. But so in Texas, there are over 4.5 million people on Medicare. The Kaiser Family Foundation projects that only 110,000 people in Texas will benefit from this new $2,000 cap. Only 110 people are going to see much higher prices for their drugs, because they're now paying for the few people that will benefit. Everybody will have much higher drug costs, higher deductibles, fewer drugs available from their drug company for those. So it's good news for some. 

REBECCA: For those who are, you know, who can benefit from this. How do they sign up? Are they going to be told about it by their pharmacist or their doctor? How does that work?  

SYLVIA: So nobody knows for sure how it looks yet, because the companies are still trying to come up with that. But the government said that the insurance companies have to notify members that they recognize will probably benefit. They have to notify them if they're already a current client. So if you're new to Medicare, you're just coming into Medicare at 65, you can enroll with your insurance company at any time of the year. Or you could do it during the annual election that's coming up this fall. You can't do it at the pharmacy yet. That will be available starting in January 2026. 

REBECCA: How can people learn more about this program and also get other Medicare tips here on social media?

SYLVIA: All over social media. Or you can go to our website, themedicarefamily.com. We have lots of free information available there.

REBECCA: All right. Sylvia Gordon, thank you so much for sharing your time with us tonight.