Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan may help you manage monthly drug costs
The Medicare Prescription Payment Plan is a payment option that may help you manage your covered Part D prescription drug costs. You can choose to spread out your covered Part D out-of-pocket prescription drug costs over the rest of the calendar year.
The Medicare Prescription Payment Plan doesn’t lower your covered Part D drug costs or save you money. It only changes how and when you pay. Your out-of-pocket Part D drug costs will still be the same at the end of the plan year, with or without the program.
How does the Medicare Prescription Payment Plan work?
If you opt in to the program, you'll no longer pay the pharmacy when you fill a prescription for a covered Part D medication. Instead of paying at the pharmacy or through home delivery, your plan will pay for your medications and send you a monthly bill for the costs. Be sure to pay your monthly bill when it’s due. If you leave the program, you’ll begin paying the pharmacy directly for future covered Part D prescriptions and will still be responsible for any remaining balance owed through the program. You’ll get a separate bill for your monthly plan premium if you have one.
You will get your bill the same way you receive other communications from us — either paperless or by regular mail.
How would my bills be calculated in the program?
Your bill can change each month, depending on when you opt in to the program and if you’ve already filled any prescriptions. Your first bill of the year will be calculated differently than the remaining months. The remaining months will be based on what you owe for your prescriptions divided by the number of months left in the year, until you reach the $2,400* out-of-pocket maximum in 2027.
Once you have reached the $2,400* annual out-of-pocket maximum, you’ll no longer accumulate costs, but you’ll still owe your remaining monthly payments for the rest of the year. Any past due balances from previous months may also be included in your bill, making the total due more than the maximum monthly amount.
*Members with coverage through their former employer or plan sponsor may have a lower out-of-pocket maximum.
It’s important to remember:
- All Medicare Part D prescription drug plans use the same formula to calculate your monthly payments under the Medicare Prescription Payment Plan
- Always pay your plan premium bill first
- Don’t include payment for your Medicare Advantage plan premium with your Medicare Prescription Payment Plan payment. Payments should always be sent separately.
Is the Medicare Prescription Payment Plan right for me?
It depends on your situation. If you decide to opt in to the program, it’s important to remember that your Medicare Prescription Payment Plan monthly bill may change. You’ll still need to pay your Part D deductible, if you have one.
The program may be a good fit for you if:
- You're likely to reach your $2,400* Part D annual out-of-pocket maximum early in the year
The program might not be a good fit for you if:
- You typically don’t reach your $2,400* Part D out-of-pocket maximum or reach it late in the year
- You're considering joining the payment program later in the year. If you enroll later, you'll have fewer months remaining to spread your prescription drug costs.
- You have a health reimbursement arrangement, health savings account or other secondary coverage
- You qualify for Extra Help or another government program to help save on your prescription drug costs
- You don’t want to change how you pay for your drugs
*Members with coverage through their former employer or plan sponsor may have a lower out-of-pocket maximum.
Do I have to join the Medicare Prescription Payment Plan?
No. Participation in the Medicare Prescription Payment Plan is voluntary. You can opt in to or out of the program at any time throughout the year. Opting in to the program might make your out-of-pocket drug costs less predictable, with the largest bills possibly coming at the end of the year. If you leave the program, you’ll still be responsible for any remaining balance owed through the program.
How do I opt in to the Medicare Prescription Payment Plan?
You can:
- Opt in online
- Call us at the toll-free phone number on your member ID card
- Complete the Medicare Prescription Payment Plan Participation Request Form and mail it to the address on the form
If your benefits are administered by your former employer, union group or trust administrator (plan sponsor), you can opt in to the program after you have enrolled in your Medicare Part D plan for the plan year.
Do I need to rejoin the program each year?
If you joined the Medicare Prescription Payment Plan, and are switching to a different UnitedHealthcare Medicare Advantage plan, you’ll need to opt in to the program again to continue for the next year. If you're staying in the same plan, your participation will continue from one calendar year to the next unless you opt out.
How would I opt out of the program?
If you decide the Medicare Prescription Payment Plan is no longer a good fit for you, you can opt out at any time. You can:
- Opt out online
- Call us at the toll-free phone number on your member ID card
If you opt out of the program, your Medicare drug coverage and other Medicare benefits won’t be affected, and you’ll go back to paying the pharmacy directly for all your covered out-of-pocket Part D drug costs.
You’ll still be expected to pay your outstanding balance if you decide to switch plans or insurance providers. You can pay the remaining balance in full or continue to pay your monthly bills through the end of the year. If your plan year ends in December, for example, you will receive a final bill in January.
If you don’t make your monthly payments, you will be removed from the program. You'll continue to receive monthly bills until your balance is paid in full. You can only rejoin the program after you pay your outstanding balance.
Are all my prescription drugs included in the program?
The Medicare Prescription Payment Plan applies to all Medicare Part D-covered prescriptions. Medicare Part A and Part B drugs and bonus drugs are not eligible to be included in the program. Off-benefit drugs, paid for with a discount card or covered by a patient assistance program (PAP), are also not included.
What programs might help lower my drug costs?
You may be eligible for programs that can help lower your costs like:
Extra Help: A Medicare program that helps pay your Medicare drug costs if you have limited income and resources. Find out if you qualify and apply at SSA.gov/extrahelp . You can also apply with your state’s Medicaid office.
Medicare Savings Program: A state-run program that helps people with limited income and resources pay some or all their Medicare premiums, deductibles and coinsurance.
State Pharmaceutical Assistance Program (SPAP): A program that may include coverage for your Medicare drug plan premiums and/or cost-sharing. SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit.
Manufacturer’s Pharmaceutical Assistance Programs Patient (sometimes called Patient Assistance Programs (PAPs)): A program from drug manufacturers to help lower drugs costs for people with Medicare.
Who can help me decide if I should opt in to the program?
- Your plan: Call us at the toll-free phone number on your member ID card
- Medicare: Visit medicare.gov/prescription-payment-plan or call 1-800-633-4227, 24 hours a day, 7 days a week; TTY users can call 1-877-486-2048
- State Health Insurance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP office and get free, unbiased and personalized health insurance counseling