Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a new payment option that helps you manage your out-of-pocket Medicare Part D drug costs by spreading them across the year. Starting in 2025, anyone with a Health New England Medicare prescription plan or Medicare health plan with drug coverage can use this payment option for drugs covered by Part D.

This program benefits members that have high out of pocket costs, and who will reach the maximum out of pocket of $2000 early in the year. If you have high costs in the beginning of the year and will hit the annual maximum, it can be a great way to budget for your prescriptions. If you do not have high-cost shares and don’t meet that larger cost threshold, it may not be a good option as it could require you pay more toward the end of the year.

This program does not reduce the cost of the drugs and members will be liable for the full cost share of their medications. There is no fee to join, no fees or interest will be charged, and members will receive a bill that must be paid monthly until all cost shares are paid back.

If you opt in, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a separate bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). It does not cost anything to participate in the Medicare Prescription Payment Plan.

If you do not pay, you will receive a reminder that you failed to pay. If you do not pay, you will be given a grace period of 60 days to pay or be terminated from the plan.

Does your drug spend exceed the annual maximum out-of-pocket (e.g. $2,000 for 2025) in the first few months of the year or period from which you elect into the Medicare Prescription Payment program? In the beginning of the year, this means more than about $200 per month; however later in the year, these expenses can be much higher. If your drug expenses exceed the annual maximum, it might help you to spread your payments out over the year.

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

• Your yearly drug costs are low.
• Your drug costs are the same each month.
• You’re considering signing up for the payment option late in the calendar year (after September).
• You don’t want to change how you pay for your drugs.
• You get or are eligible for Extra Help from Medicare.
• You get or are eligible for a Medicare Savings Program.
• You get help paying for your drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP), a coupon program, or other health coverage.

For example, if you have high dollar drug(s) with a cost share of $1,214.63 in the first month of the year, you would have met the annual out-of-pocket in February. By electing into the program at the beginning of the plan year, the cost would be spread over the year and you would pay approximately $166.67 each month.

If you are unsure whether the Medicare Prescription PlanProgram is right for you and want further advice, contact Optum CustomerService at (800) 393-0395.

Let's say you have lower dollar drug(s) with a cost share of in the first months of the year (you would NOT likely meet the annual out-of-pocket), electing in the program will not likely benefit you long-term and could actually cause you to owe more at the end of the plan year.

In the example below, the member only has an $18.00 monthly cost and if they spread it out they would only pay $1.64 the first month the payment was spread but as the total amount owed over the year increases and months left in the year decrease the monthly payment goes up to $54.35.

If you want to participate in the Medicare Prescription Payment Plan for 2025, contact your plan now. Your participation will start January 1, 2025. If approved, you will be given an approval letter within 10 days prior to the plan’s start.

Register

Starting January 1, 2025, you can contact your plan to start participating in the Medicare Prescription Payment Plan anytime during the calendar year.

If a member has a high-cost prescription and they’ve decided they want to participate in the Medicare Prescription Payment Plan and need the medication urgently, they can request more information.

If you want more information directly from Medicare on this program, click here to be redirected to the CMS website information page.