Medicare Prescription Payment Plan

Frequently Asked Questions

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. Go to  Medicare.gov/prescription-payment-plan/will-this-help-me  to answer a few questions, and find out if you’re likely to benefit from this payment option. 

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.

How do I sign up?

You can contact your plan to start participating in the Medicare Prescription Payment Plan anytime during the calendar year. Contact your plan at the phone number listed in the Contact Us section. Your plan will process your Medicare Prescription Payment Plan election request within 24 hours during the plan year.

What happens if I don't pay my bill?

You’ll get a reminder from your health or drug plan 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. You’re required to pay the amount you owe, but you won’t pay any interest or fees, even if your payment is late. You can choose to pay that amount all at once or be billed monthly. If you’re removed from the Medicare Prescription Payment Plan, you’ll still be enrolled in your Medicare health or drug plan.

How do I leave?

You can leave the Medicare Prescription Payment Plan at any time by contacting your health or drug plan and your drug plan will send you a letter confirming your removal from the Medicare Prescription Payment Plan. Leaving won't affect your Medicare drug coverage and other Medicare benefits.

Is there a Medicare Prescription Payment Plan retroactive election process if I have an urgent prescription that I cannot wait to pick up?

Yes, you can request a retroactive election by calling your plan.

A retroactive election will be processed if all the following conditions are met:

• If you believe that any delay in filling your prescription(s) may seriously jeopardize their life, health, or ability to regain maximum function; and
• If you request retroactive election within 72 hours of the date and time you picked up and paid for your prescription(s).

Once your Medicare Prescription Payment Plan election has been effectuated, your drug plan must process your reimbursement for all cost sharing for the urgent prescription(s) and any covered Part D prescription(s) filled between when you picked up and paid for your urgent your prescription(s) and the date that your election is effectuated within 45 calendar days.

If your drug plan determines that you failed to request retroactive election within the required timeframe, it must promptly notify you of its determination and provide instructions on how to file a grievance.

How can I file a grievance or complaint related to the Medicare Prescription Payment Plan?

If you need to file a grievance or complaint related to the Medicare Prescription Payment Plan, call your drug plan.