Medicare Prescription Payment Plan
Effective January 1, 2025
The Medicare Prescription Payment Plan is a payment option that may help you manage your prescription drug costs. Under the Medicare Prescription Payment Plan, members can pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year instead of all at once to the pharmacy. Plan participants will pay $0 to the pharmacy for covered Part D drugs, and Advantage MD will then bill members monthly for any cost sharing they incur.
Should I sign up for the Medicare Prescription Payment Plan?
Whether or not the payment plan is right for you depends on your situation.
You may benefit from the payment plan if you:
- Have high out-of-pocket drug costs early in the year
- Are prescribed a higher cost drug during the year and want to spread out the cost of your next refill
- If you prefer to spread out your drug costs rather than pay everything at once
You may not benefit from the payment plan if you:
- Have low yearly drug costs and/or your drug costs are about the same each month
- You do not want to change how you pay for your drugs
- You qualify for Extra Help from Medicare or another organization or program
Still unsure if the payment plan is right for you? Find personal guidance:
- Caremark.com: Visit Caremark.com/mppp to enter your individual drug costs into the Out-of-Pocket (OOP) Billing Forecast tool to see how your future drug costs and the date of fill would impact your estimated monthly payments.
- Medicare: Visit Medicare.gov/prescription-payment-plan to learn more about this payment option and if it might be a good fit for you.
- 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 for the Medicare Prescription Payment Plan?
- Complete the form online at Caremark.com/mppp
- Call Customer Service at:
877-293-5325 (PPO) or 877-293-4998 (HMO) (TTY: 711)
You can sign up for this payment option at any time during the plan year. Requests to enroll in the payment plan before the plan year begins will be processed in 10 calendar days after receipt. Requests to enroll during the plan year will be processed within 24 hours of receipt.
Is there a cost to participate in the Medicare Prescription Payment Plan?
There is no cost to sign up for or participate in the payment plan. There are no fees or interest that you will have to pay. The only costs are the copays and co-insurance amounts of the prescription drugs you fill. The payment plan will spread those costs out over the course of the year.
How will my costs work in the payment plan?
The payment plan will not reduce the amount of cost-sharing you are responsible for, it just spreads those costs out. In 2025, the maximum you could spend on prescription drugs is $2,000. This is true for everyone with Medicare drug coverage, even if you do not join the Medicare Prescription Payment Plan.
In the payment plan, when you fill a prescription for a drug covered by Part D, you will not pay your pharmacy (including mail order and specialty pharmacies). Instead, you will get a bill each month from Advantage MD. 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.
Even though you will not pay for your drugs at the pharmacy, you are still responsible for the costs. If you want to know what your drug will cost before you take it home, call Advantage MD, visit caremark.com or ask the pharmacist.
Note: 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). As new out-of-pocket drug costs get added to your monthly payment, there are fewer months left in the year to spread out your remaining payments.
What are some examples of how the payment plan works?
View these charts that illustrate a few examples of how the payment plan works and who may benefit. Medicare Prescription Payment Plan Examples
Can I leave the Medicare Prescription Payment Plan?
You can leave the Medicare Prescription Payment Plan at any time by calling Customer Service at 877-293-5325 (PPO) or 877-293-4998 (HMO) (TTY: 711). Leaving will not affect your Medicare drug coverage and other Medicare benefits.
Keep in mind:Collapse
- Your participation in the Medicare Prescription Payment Plan will end if you leave or change your Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage). Contact your new plan if you’d like to participate in the Medicare Prescription Payment Plan again.
- If you still owe a balance, you are required to pay the amount you owe, even though you are no longer participating in this payment option.
- You can choose to pay your balance all at once or be billed monthly.
- You will pay the pharmacy directly for new out-of-pocket drug costs after you leave the Medicare Prescription Payment Plan.
How can I file a complaint or grievance for the Medicare Prescription Payment Plan?
To file a complaint or grievance related to the Medicare Prescription Payment Plan, visit: hopkinsmedicare.com/members/appeals-and-grievances for instructions.
Where can I find more information on the Medicare Prescription Payment Plan?
Call Caremark for more information and support signing up:
877-293-5325 (PPO) or 877-293-4998 (HMO) (TTY: 711); option 2
October 1 – March 31, Monday through Sunday 8 a.m. – 8 p.m. and April 1 – September 30, Monday through Friday 8 a.m. – 8 p.m.
Are there any other resources to manage my prescription drug costs?
An additional or alternative option to lower prescription drug costs is the low income subsidy (LIS). Also known as Extra Help, LIS is a program that helps individuals who have a limited income pay for their Medicare prescription drug costs. LIS enrollment, for those that qualify, is likely to provide more benefit than the Medicare Prescription Payment Plan. If you get extra help from Medicare to pay for your prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our plan. LIS has expanded eligibility.
Apply for LIS: ssa.gov/medicare/part-d-extra-help or call 800-772-1213 (TTY: 800-325-0778) and tell the representative you want to set up an appointment to apply for Part D Extra Help.
Are there any other resources to manage my prescription drug costs?
An additional or alternative option to lower prescription drug costs is the low income subsidy (LIS). Also known as Extra Help, LIS is a program that helps individuals who have a limited income pay for their Medicare prescription drug costs. LIS enrollment, for those that qualify, is likely to provide more benefit than the Medicare Prescription Payment Plan. If you get extra help from Medicare to pay for your prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our plan. LIS has expanded eligibility.
Apply for LIS: ssa.gov/medicare/part-d-extra-help or call 800-772-1213 (TTY: 800-325-0778) and tell the representative you want to set up an appointment to apply for Part D Extra Help.
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