Medicare Prescription Payment Plan

What is the Medicare Prescription Payment Plan?

The Medicare Prescription Payment Plan is a program starting in 2025 that helps you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January – December). This could be a benefit if you have high drug costs, especially early in the year.

If you are happy with how you currently pay for your Medicare Part D drugs, your drug costs are low or are the same each month, or if you get help paying for your drugs through other programs such as Extra Help, this payment option might not be the best choice for you.

This is a voluntary payment option offered by all Medicare Part D plans. There’s no cost to participate. This program might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.

The prescription drug law caps your out-of-pocket costs at $2,000 in 2025. This means you’ll never pay more than $2,000 in out-of-pocket Medicare Part D drug costs in 2025. This is true for everyone with Medicare Part D drug coverage, even if you don’t choose to participate in this payment option.

How the Medicare Prescription Payment plan works

• You will continue to pay your Medicare Part D plan premium (if you have one) as you currently do. Always pay your monthly premium first (if you have one), so you don’t lose your drug coverage.
• If you sign up for the Medicare Prescription Payment Plan in 2024, your participation starts on January 1, 2025. After January 1, 2025, you can sign up any time during the year.
• If your participation is approved, you’ll get a letter with information about how to pay your bill. When a pharmacist submits a claim for your prescription, we will let the pharmacy know that you are participating in this payment option.
• When you fill a prescription for a drug covered by Medicare Part D, you will get a bill each month instead of paying at the pharmacy (including mail order and specialty pharmacies).
• Your monthly bill will be based the cost of your prescriptions, plus any previous month’s balance, divided by the number of months left in the year.
• You are still responsible for all Medicare Part D out-of-pocket drug costs. If you want to know what a prescription will cost you, call your Medicare Part D drug plan or ask the pharmacist.

To opt-out or leave the Medicare Prescription Payment Plan or to file a complaint or grievance, call
1-833-696-2087, TTY 711

After you opt-out:

• You will continue to receive an invoice each month for the amount you owe until the balance of what you owe through the Medicare Prescription Payment Plan is paid in full.
• You will need to pay your cost share for your prescription drugs at the pharmacy at the time of pick up.