The Medicare Prescription Payment Plan
Let’s talk about a program that’s new for 2025. It’s called the Medicare Prescription Payment Plan.
We’ll walk you through the following items on this page:
The Medicare Prescription Payment Plan is new for 2025. It:
- Came from the Inflation Reduction Act of 2022 and is part of the prescription drug law
- Is a way to pay for your prescription drugs
- Let’s you spread your out-of-pocket Medicare Part D drug costs over the calendar year (January–December)
- Works with your prescription drug coverage as part of your Medicare drug plan or health plan with drug coverage
- Is offered by all Medicare Advantage and prescription drug plans
- Doesn’t cost anything to participate
- Is voluntary
Watch a short video about the Medicare Prescription Payment Plan
You choose to participate in the Medicare Prescription Payment Plan.
You go to a network pharmacy and pay nothing for your covered drug(s).
We will send you a bill each month. It‘ll have the amount you owe, due date, and how to pay.
If your plan has a premium, we’ll send you a separate bill for the premium.
You pay the owed Medicare Prescription Payment Plan amount by the due date.
This repeats until the end of the year (December). Or until you’ve paid your full Medicare Prescription Payment Plan balance.
More important information about how the Medicare Prescription Payment Plan works
- Even though you won’t pay for your drugs at the pharmacy, you still have to pay for the costs.
- If you want to know what your drug will cost before you take it home, call us or ask your pharmacist.
- Always pay your Arkansas Blue Medicare monthly premium first (if you have one). This way, you won’t lose your drug coverage.
Very important
The Medicare Prescription Payment Plan may help you manage your monthly drug costs, but it doesn’t save you money or lower your drug costs.
Keep reading for information about programs that might help you save money.
More important information about your monthly Medicare Prescription Payment Plan bills
- Future bill amounts might change each month
- They may increase when you fill a new prescription or refill an existing prescription
- This is because as new out-of-pocket costs get added to your monthly bill, there are fewer months left in the year to spread your remaining bills
- There are no late fees
- Interest is not charged
- You’ll never pay more than the amount you would have paid at the pharmacy if you had not participated in the Medicare Prescription Payment Plan
- You will never pay more than the Medicare yearly drug out-of-pocket maximum, which is $2,000 in 2025
You need to think about your own situation. Your out-of-pocket costs won’t be lowered. Medicare Prescription Payment Plan will only help to spread out your costs over the year instead of immediately at the pharmacy.
Should I do Medicare Prescription Payment Plan?
I’ll be able to spread my drug costs over the plan year instead of paying upfront at the pharmacy when I pick up my prescription(s)
If I have an expensive drug cost share, I’ll pay $0 at the pharmacy and spread the cost over the months left in the year
With an expensive drug, I’ll want to start participating in Medicare Prescription Payment Plan earlier in the year (with more months to spread the costs)
With an expensive drug, I’ll want to start participating in Medicare Prescription Payment Plan earlier in the year (with more months to spread the costs)
Should I not do Medicare Prescription Payment Plan?
It doesn’t lower my drug costs
I don’t want to participate if I fill an expensive drug later in the year (since there will be fewer months left to spread the costs)
Medicare Prescription Payment Plan is not a good thing for me if I like having the same drug costs each month
Medicare Prescription Payment Plan is not a good thing for me if I like having the same drug costs each month
If I like paying upfront at the pharmacy and don’t want to receive a bill, Medicare Prescription Payment Plan is not what I want
If I get “Extra Help” from Medicare paying for my covered drugs, Medicare Prescription Payment Plan won’t really benefit me
If I am in a Medicare Savings Program (e.g., Qualified Medicare Beneficiary), Medicare Prescription Payment Plan won’t really benefit me
If I get help paying for my drugs from a third party, like a State Pharmaceutical Assistance Program (SPAP), a coupon program, or other health coverage, again, Medicare Prescription Payment Plan isn’t the best way to go
Still not sure if Medicare Prescription Payment Plan is right for you? Don’t worry. Here are some ideas on where to go for more help:
Go to Medicare.gov/prescription-payment-plan/will-this-help-me. Answer a few questions. You’ll get some additional information.
Give us a call. Call 844-280-5833 (TTY: 711) 24 hours a day, seven days a week. We’re happy to answer your questions. Especially call us if you need to get a prescription right away.
Visit this web page often. We’ll keep this information up-to-date for you. We’ll also add more resources as they become available.
Talk with the Seniors Health Insurance Information Program. It’s Arkansas’ State Health Insurance Assistance Program. They give free local health insurance counseling to people with Medicare. Call them at 800-224-6330 (TTY: 711). Or visit their website at www.shiipar.com.
Visit Medicare.gov/prescription-payment-plan or call 800-MEDICARE (800-633-4227), 24 hours a day, seven days a week. TTY users can call 877-486-2048.
You’ll need to sign up for it.
- Click here to get a copy of the Medicare Prescription Payment Plan request form. Fill it out and send it to:
- Arkansas Blue Medicare
Medicare Prescription Payment Plan
P.O. Box 7
Pittsburgh, PA 15230
- Arkansas Blue Medicare
- Call us. We’ll help you enroll. Call 844-280-5833 (TTY: 711) 24 hours a day, seven days a week.
- Complete a request form online.
Timing of your participation in the Medicare Prescription Payment Plan will depend on when you submit your request:
In 2024, for 2025: If you want to participate in the Medicare Prescription Payment Plan for 2025, complete your request form now. Your participation will start January 1, 2025.
During 2025 (should be earlier than September): Starting January 1, 2025, you can complete a request form and start in the Medicare Prescription Payment Plan anytime during the calendar year.
Remember: The Medicare Prescription Payment Plan may not be the best choice for you if you sign up late in the calendar year (after September). That’s because as new out-of-pocket drug costs are added to your monthly bill, there are fewer months left in the year to spread out your payments.
Once your request form is received and approved, you’ll be in the Medicare Prescription Payment Plan. Next:
- We’ll send you a letter to confirm you are in the Medicare Prescription Payment Plan.
- The next time you go to the pharmacy for your covered prescription, we will tell them you are in the Medicare Prescription Payment Plan.
- You won’t pay anything at the pharmacy. (Even though you won’t pay then, you are still responsible for the costs.)
- If you want to know how much your prescription will cost, ask the pharmacist. Or call us.
- You’ll get a bill in the mail from us each month and it will tell you:
- How much you owe.
- The due date
- How you can pay your bill.
What happens if I don’t pay my Medicare Prescription Payment Plan bill?
You’ll get a reminder from us if you miss a payment. The reminder will include a due date for your payment. If you don’t pay by the date in the reminder, you’ll be removed from the Medicare Prescription Payment Plan.
You’re required to pay the amount you owe. There are no late fees or interest, even if you’re late. You can pay your full owed amount all at once. Or you can be billed monthly.
If you’re removed from the Medicare Prescription Payment Plan, you’ll still be enrolled in your Arkansas Blue Medicare plan.
Important: Always pay your Arkansas Blue Medicare monthly premium first (if you have one). That way you won’t lose your drug coverage.
Call us if you think we made a mistake about your Medicare Prescription Payment Plan bill. You can file a complaint/grievance about it with us. Read how to file a complaint/grievance in your Evidence of Coverage (EOC).
You can leave the Medicare Prescription Payment Plan at any time by contacting us. Keep in mind:
- If you still owe a balance, you have to pay the amount you owe, even though you’re no longer in the Medicare Prescription Payment Plan.
- You can choose to pay your balance all at once. Or you can be billed monthly.
- After you leave the Medicare Prescription Payment Plan, you’ll pay the pharmacy for any new prescriptions and/or refills.
- Leaving the Medicare Prescription Payment Plan won’t affect your Arkansas Blue Medicare coverage.
If you leave our plan to go to another Medicare drug plan or health plan with drug coverage, your participation in the Medicare Prescription Payment Plan will end.
You should contact your new plan if you want to join the Medicare Prescription Payment Plan again.
As we explained, Medicare Prescription Payment Plan won’t help you save on your drug costs. It only helps you to manage them.
If you’re worried about paying both your plan premium (if you have one) and Medicare Prescription Payment Plan bill: Always pay your plan premium. You don’t want to lose your drug coverage.
If you have limited income and resources, you can find out if you’re eligible for financial assistance from one of these programs:
“Extra Help”
- It’s a Medicare program that helps pay your Medicare drug costs
- Visit ssa.gov/medicare/part-d-extra-help to find out if you qualify and to apply
- You can also apply with your State Medical Assistance (Medicaid) office
- Visit Medicare.gov/medicare-savings-programs to learn more
Medicare Savings Programs
- These are state-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance
- Visit Medicare.gov/medicare-savings-programs to learn more
State Pharmaceutical Assistance Programs (SPAPs)
- These are other programs that might cover your Medicare drug plan premiums and/or cost sharing
- SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit (which is $2,000 for 2025)
- Visit go.medicare.gov/spap to learn more
Manufacturer Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs))
- These are programs from drug manufacturers to help lower drugs costs for people with Medicare SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit (which is $2,000 for 2025)
- Visit go.medicare.gov/pap to learn more
Many people qualify for savings and don’t know it. To learn more:
- Visit Medicare.gov/basics/costs/help
- Contact your local Social Security office (you can find your local Social Security office at ssa.gov/locator/)
Below are a few examples of how the Medicare Prescription Payment Plan costs are figured. Click on each one for full details.
Example one
- You take several high-cost drugs
- They cost you $500 each month
- You decide to join the Medicare Prescription Payment Plan in January 2025
Example two
- You take several drugs that cost you $80 each month
- You decide to join the Medicare Prescription Payment Plan in January 2025
Example three
- You pay $4 every month for a prescription you take regularly
- In April, you need a new one-time prescription that costs $613
- Your total costs in April will be $617
There’s a lot of information here. To get it in a printable format, click here. Now, let’s get started!
We hope you found this information helpful. If you have any questions or need help, please call us.
844-280-5833
(TTY: 711)
24 hours a day, seven days a week
Return to top