Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new option starting in 2025 that anyone with a Part D plan, like those with a Medicare Advantage plan that includes Part D prescription drug coverage, can use. Signing up is voluntary.

Whether you sign up or not, you will not pay more than $2,000 out of pocket for your Part D prescription drugs in 2025.

Is the payment option right for me?

You’re most likely to benefit if you have high drug costs earlier in the calendar year. If you sign up for the payment option later in the year, you will have fewer months to spread out your drug costs. It’s important to remember that this payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.

This payment option may not be the best choice for you if:

Are there other programs that might be more beneficial for me than the Medicare Prescription Payment Plan?

People with limited incomes may qualify for "Extra Help" to pay for their prescription drug costs. This is called the Low Income Subsidy (LIS) program. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, copays and/or coinsurance. Additionally, those who qualify will not be subject to a late enrollment penalty.

Many people are eligible for these savings and don’t even know it. If you qualify, this is likely to be more beneficial than enrolling in the Medicare Prescription Payment Plan. For more information about this "Extra Help," contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

To find out more about Medicaid and its programs, contact:

How does the payment plan work?

The Inflation Reduction Act (IRA) eliminates the coverage gap and limits drug costs to $2,000. Your drug plan may reduce these out-of-pocket drug costs even further. Additionally, the payment plan can help spread your out-of-pocket drug costs over the plan year.

When you fill a prescription covered by Part D, you won’t pay your pharmacy. Instead, you’ll get a bill from your health or drug plan. Your monthly bill is calculated using the following equation:

Your payments may increase when you fill a new prescription or refill an existing prescription because as new out-of-pocket drug costs are added to your monthly payment, there are fewer months left in the year to spread out your payments. Because of this, you may not know what your exact bill will be ahead of time. Calculate costs to see what your estimated payments may be.

How do I join the payment plan?

You can opt in to the Medicare Prescription Payment Plan over the phone, by mail or online. Log in to your member portal to get started.

You can leave the plan at any time by contacting at us 1-866-845-1803/TTY 1-800-716-3231. You will still be required to pay any balances you owe and will need to pay the pharmacy directly for new out-of-pocket costs.

How do I pay my bill?

Each month, we will send you a bill with the amount you owe for your prescriptions. You will get a separate bill for your monthly plan premium if you have one. It doesn’t cost anything to opt in to the payment plan, and you won’t pay any interest or fees on the amount you owe even if your payment is late. If you have questions or want more information, go to Medicare.gov/prescription-payment-plan.

What if I don’t pay my bill?

We will send you a reminder if you miss a payment. If you don’t pay your bill by the date listed in that reminder, you’ll be removed from the Medicare Prescription Payment Plan, but will still be enrolled in your Medicare Advantage plan. You will still be required to pay the amount you owe for the payment plan, but won’t pay any interest or fees.

You should always pay your Medicare Advantage monthly premium first (if you have one), so you don’t lose your drug coverage. Call us at 1-866-845-1803/TTY 1-800-716-3231 if you think we made a mistake with your payment plan bill.

What if I filled an urgent prescription before I joined the plan?

You can request a retroactive enrollment into the payment plan within 72 hours of filling the prescription if you believe that a delay in filling the prescription could have been life-threatening. Call 1-866-845-1803/TTY 1-800-716-3231 for this enrollment option.

How do I file a complaint or grievance about the Medicare Prescription Payment Plan?

For information on filing a complaint or grievance, visit the section on Grievances & Appeals.

How do I get more information about the Medicare Prescription Payment Plan?

To learn more about the Medicare Prescription Payment Plan, you can call us at 1-866-845-1803/TTY 1-800-716-3231. You can also visit Medicare.gov/prescription-payment-plan, or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.