The Medicare Prescription Payment Plan is a voluntary payment option offered by all Medicare insurers with Part D plans. There are no fees or interest charges associated with the program. Participation in the plan does not reduce the amount you owe for your Part D prescriptions. Your cost-sharing responsibilities remain the same, but payment is more flexible.

• You will continue to pay your Medicare Part D plan premium as usual. Always pay your monthly premium first to maintain your drug coverage.

• If you enroll in the Medicare Prescription Payment Plan in 2024, your participation will begin on January 1, 2025. You can sign up at any time during the year starting January 1, 2025.
• Once approved, you’ll receive a letter with instructions on how to manage your payments. When a pharmacy submits a claim for your prescription, they will be notified that you’re using this payment option.
• Instead of paying at the pharmacy (including mail order and specialty pharmacies), you’ll receive a monthly bill based on the cost of your prescriptions and any outstanding balance, divided by the number of months remaining in the year. For details on how drug payments are calculated, refer to the Medicare Prescription Payment Plan Fact Sheet.
• You remain responsible for all out-of-pocket costs for Medicare Part D drugs. For information on prescription costs, contact your pharmacist.

Timely payment of your monthly bills is crucial. Failure to make payments on time can result in:

• Disruption of Prescription Services: Your medications may be delayed or interrupted.
• Termination of Coverage: Persistent non-payment will cause your coverage to be terminated.

• "Extra Help" from Medicare and help from your State Pharmaceutical Assistance Program (SPAP) and ADAP, for those who qualify, is more advantageous than participation in the Medicare Prescription Payment Plan.
• Extra Help is a financial assistance program for Medicare beneficiaries with limited income and resources. It helps cover costs associated with Medicare Part D, including monthly premiums, copays, and coinsurance.
• For free, personalized health insurance counseling, visit shiphelp.org to find the contact information for your local State Health Insurance Assistance Program (SHIP).
• All members are eligible to participate in this payment option, regardless of income level, and all Medicare drug plans and Medicare health plans with drug coverage must offer this payment option.

Visit https://m3p-form.optumrx.com/?cid=SHPM3Pto start your request or call (844) 368-8729 TTY: 711 from 8 a.m. to 8 p.m. local time, 7 days a week.

Make sure to submit your requests with enough lead time to avoid disruptions in your prescription payments.

When you opt out of the Medicare Prescription Payment Plan, the following will occur:

• You will start paying your pharmacy directly for all covered Part D drug costs, including those from mail order and specialty pharmacies.
• Purchases will no longer be added to your balance. 
• You will continue to receive monthly bills for any remaining balance accrued while you were in the program until it is fully paid. 
• You can choose to pay off the balance in full at any time.
• If you decide to rejoin the program in the future, you can opt-in again as you did before.

Yes, your participation in the Medicare Prescription Payment Plan ends on December 31. To continue with the program in the new plan year, you must re-enroll for a January 1 start date.

Urgent requests for the Medicare Prescription Payment Plan can be made under certain circumstances. If you face an urgent need due to financial hardship or unexpected medical expenses, call (844) 368-8729 TTY: 711 from 8 a.m. to 8 p.m. local time, 7 days a week.

If you experience issues or disagree with our decision on the Medicare Prescription Payment Plan, You or your appointed representative can call (888) 278-6485 (TTY: (888) 279-1549) to file a grievance. For more on this process, refer to “What to do if you have a problem or complaint (coverage decisions, appeals, complaints)” in your Evidence of Coverage.

Visit Medicare.gov/prescription-payment-planor call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048 for additional information.