Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan may help manage monthly drug costs
The Centers for Medicare & Medicaid Services (CMS) has created a new payment option that may help you manage your covered Part D prescription drug costs. Starting Jan. 1, 2025, you can choose to spread out your covered Part D out-of-pocket prescription drug costs over the rest of the calendar year.
The Medicare Prescription Payment Plan doesn’t lower your covered Part D drug costs or save you money. It may be helpful if you want to spread the payment of your covered Part D drug costs across the remaining months of the year.
How does the Medicare Prescription Payment Plan work?
If you opt in to the program, you will no longer pay the pharmacy when you fill your covered Medicare Part D prescriptions. Instead, your plan will pay and send you a monthly bill. You’ll get a separate bill for your monthly plan premium if you have one.
It’s important to know the Inflation Reduction Act (IRA) of 2022 eliminates the Coverage Gap or “donut hole” and caps covered Part D prescription drug costs at $2,000 in 2025. This is true for everyone with Part D coverage, even if you don’t join the Medicare Prescription Payment Plan.
For more information, see the Medicare Prescription Payment Plan Fact Sheet.
Is the Medicare Prescription Payment Plan right for me?
High Fit
The program might be a good fit for you if:
You have high covered Part D drug costs
You will hit the $2,000 annual out-of-pocket maximum amount before September
You want to spread your covered Part D drug costs throughout the rest of the year
In this example from CMS, rather than paying $500 out-of-pocket per month for the first 4 months of the year for a covered Part D drug, a program participant would pay about $181.32 per month over the course of the calendar year. This is only one example of how the program would work. Each person’s situation will depend on their plan’s structure and their personal prescription needs.
Low Fit
The Medicare Prescription Payment Plan might not be a good fit for you if:
Your yearly covered Part D drug costs are low and about the same each month
You’re not likely to hit the $2,000 annual out-of-pocket maximum
You qualify for Extra Help or another government program to help save on your covered Part D prescription drug costs
In this example from CMS, a person whose covered Part D prescription drugs always cost $55 out-of-pocket per month would not reach the $2,000 out-of-pocket maximum for the year. In this scenario, you would end up paying less at the beginning of the year but more at the end. Each member’s circumstances will differ.
Frequently Asked Questions:
You may qualify for one of the following programs to help reduce your prescription drug costs:
Extra Help: A Medicare program that helps you pay your drug costs if you have limited income and resources
Medicare Savings Program: A state-run program that helps people with limited income and resources pay some or all their Medicare premiums, deductibles, and coinsurance. Visit medicare.gov/medicare-savings-programs to learn more.
State Pharmaceutical Assistance Program (SPAP): A program that may include coverage for your Medicare drug plan premiums and/or cost sharing. SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit. Visit go.medicare.gov/spap to learn more.
Manufacturer’s Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs): A program from drug manufacturers to help lower drug costs for people with Medicare. Visit go.medicare.gov/pap to learn more.
Your monthly bill may change each month. Your bill will be based on what you owe for your prescriptions divided by the number of months left in the year. You won’t pay any interest or fees on the amount you owe, even if your payment is late.
You should always pay your plan premium bill first. Do not include payment for your Medicare plan premium with your Medicare Prescription Payment Plan payment. Payments should always be sent separately.
Your future payments increase as you continue to fill your prescriptions throughout the rest of the year. All Medicare Part D prescription drug plans use the same formula to figure out your monthly payments under the Medicare Prescription Payment Plan.
No. Participation in the Medicare Prescription Payment Plan is not required and may not be a good fit for everyone. You can opt in to or out of the program at any time throughout the year.
If you think this payment option is right for you, you have several ways to opt in:
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Complete the Medicare Prescription Payment Plan Participation Request Form online. (A link to this form can also be found on the bottom of this page.)
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Call Member Services at (800) 263-0067, TTY 711. Please note: From October 1 through February 14, Member Services is available 8:00 a.m. to 8:00 p.m., seven days a week. From February 15 through September 30, Member Services is closed on Saturdays and Sundays. Member Services is also closed on holidays. If you call when Member Services is closed, you can leave a voice message. An agent will return your call no later than the next business day.
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Mail in the completed Medicare Prescription Payment Plan Participation Request Form to:
PHP
P.O. Box 46160
Los Angeles, CA 90046
All Medicare Part D covered prescription drugs are included in the Medicare Prescription Payment Plan. Medicare Part B drugs and bonus drugs are not eligible to be included in the program. Off-benefit drugs paid for with a discount card are also not included.
If you decide the Medicare Prescription Payment Plan is no longer a good fit for you, you can opt out at any time. In order to opt out you can contact Member Services.
If you leave the program, your Medicare drug coverage and other Medicare benefits won’t be affected, and you’ll go back to paying the pharmacy directly for all your covered out-of-pocket Part D drug costs.
You are still required to pay your outstanding balance if you decide to switch plans or insurance providers. You can pay the remaining balance in full or continue to pay your monthly bills through the end of the year. If your plan year ends in December, for example, you will receive a final bill in January.
If you don’t make your monthly payments, you will be removed from the program. You will continue to receive monthly bills until your balance is paid in full. You can only rejoin the program after you pay your outstanding balance.
PHP: Contact Member Services for more information
Medicare: Visit medicare.gov/prescription-payment-plan or call 1-800-633-4227, 24 hours a day, 7 days a week; TTY users can call 1-877-486-2048
State Health Insurance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP office and get free, unbiased and personalized health insurance counseling
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