Before using this payment option
How does it work?
When you fill a prescription for a drug covered by Part D, you won’t pay your pharmacy (including mail order and specialty pharmacies). Instead, you’ll get a bill each month from your health or drug plan.
How is my monthly bill calculated?
Your monthly bill is based on what you would have paid for any prescriptions you get, plus your previous month’s balance, divided by the number of months left in the year. All plans use the same formula to calculate your monthly payments. Review examples of how this payment option works in different situations.
Your payments might change every month, so you might not know what your exact bill will be ahead of time. Future payments might increase when you fill a new prescription (or refill an existing prescription) because as new out-of-pocket costs get added to your monthly payment, there are fewer months left in the year to spread out your remaining payments.
In a single calendar year (January – December), you’ll never pay more than:
- The total amount you would have paid out of pocket to the pharmacy if you weren’t participating in this payment option.
- The out-of-pocket maximum for prescription drugs that are covered by your plan ($2,000 in 2025).
Will this help me?
It depends on your situation. Remember, this payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.
You’re most likely to benefit from participating in the Medicare Prescription Payment Plan if you have high drug costs earlier in the calendar year. Although you can start participating in this payment option at any time in the year, starting earlier in the year (like before September), gives you more months to spread out your drug costs. Answer a few questions to find out if this payment option is likely to help you.
If there’s a drug that you’d like to take but it’s too expensive, and you think this payment option might spread out the cost enough to work for you, contact your plan to confirm the drug is covered and get more help.
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 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.
Learn about programs that can help lower your costs.
Who can help me decide if I should participate?
- Your health or drug plan: Visit your plan’s website, or call your plan to get more information.
- State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling.
How do I sign up?
Visit your health or drug plan’s website, or call your plan to start participating in this payment option:
- In 2024, for 2025: If you want to participate in the Medicare Prescription Payment Plan for 2025, contact your plan now. Your participation will start January 1, 2025.
- During 2025: Starting January 1, 2025, you can contact your plan to start participating in the Medicare Prescription Payment Plan anytime during the calendar year.
Remember, this payment option may not be the best choice for you if you sign up late in the calendar year (after September). This is 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.
Where can I get more information?
Visit your health or drug plan’s website, or call your plan to get more information.
What do you want to do next?
What to know if I’m participating
Understand what happens once you’re using this payment option.
Will this payment option help me
Answer a few questions to get a recommendation for your specific situation.
Review Examples
Understand how this payment option spreads your costs in different situations.