Medicare Prescription Payment Plan

A new way to help manage your prescription costs

The Medicare Prescription Payment Plan can help you manage your out-of-pocket Part D drug costs by spreading them across the calendar year (January-December). It’s optional and free of charge.

The payment plan may be beneficial for members who have high out-of-pocket prescription drug costs early in the year. Watch this video to learn more.

What is the Medicare Prescription Payment Plan?

Starting in 2025, you won’t pay more than $2,000 out-of-pocket for covered Part D prescription drugs.

If you take high-cost Part D drugs, you may reach the spending cap and pay the full $2,000 early in the year. This is where the new Medicare Prescription Payment Plan might benefit you. If you opt in to the payment plan, you will be able to spread your out-of-pocket costs across the calendar year versus having to pay it all within the first few months.

Let’s look at one of our members, John. He takes a high-cost prescription drug for his chronic heart condition. It makes sense for John to opt in to the payment plan beginning in January because he’ll reach his annual $2,000 out-of-pocket limit by April. The payment plan will help John smooth out his costs over the course of the entire year, allowing him to make smaller payments each month.

Please see the FAQ below for more detailed examples or visit the Medicare website to learn more. You can also access the fact sheet for more information.

Medicare Prescription Payment Plan Chart

How does the payment plan work?

The Medicare Prescription Payment Plan is voluntary and free of charge. If you opt in to the payment plan, you won’t pay for your Part D prescription drugs at the pharmacy, or when they’re shipped. Instead, our pharmacy partner, CVS Caremark®, will send you a bill each month. The total amount due will be based on the Part D prescription drugs you filled that month, plus your previous month’s balance, divided by the number of months left in the plan year. You’ll make your monthly payments directly to CVS Caremark.

Nota: The Medicare Prescription Payment Plan might help you manage your expenses, but it doesn’t save you money or lower your drug costs.


Please visit the Medicare website to learn about programs that can help lower your prescription drug costs.

How do I know if the payment plan is right for me?

It depends on your situation. If you’re likely to reach the $2,000 out-of-pocket cap early in the year, and you opt in to the payment plan early, before you fill many prescriptions, it might benefit you. Please see the FAQ below for some examples.

How do I opt in to the payment plan?

To sign up, please log in to your CVS Caremark account. If you don’t have an account, you can create one here. After you’re logged in, go to go to the Medicare Prescription Payment Plan program page.

You can also call our dedicated prescription help line at 1-855-222-3183 (TTY:711) to sign up. For more detailed information, please see the FAQ below.

Preguntas frecuentes

Cómo comenzar

Close
Medicare Prescription Payment Plan Example 1Medicare Prescription Payment Plan Example 2Medicare Prescription Payment Plan Example 3
Who is most likely to benefit from the payment plan?
Who is not likely to benefit from the payment plan?
How will my drug costs work with the payment plan?
Can I see examples of how the payment plan may or may not benefit me?
If I qualify for financial assistance, will the payment plan still benefit me?
Who can help me decide if I should opt in to the payment plan?

Opting in and out

How do I opt in to the prescription payment plan?
I just opted into the plan, but I need my medication now. ¿Qué debo hacer?
If I choose to opt out of the payment plan, can I join again in the future?
I just paid a high cost for an urgent prescription fill. Can I opt in to the program and cover the cost that I already paid?

Pagos

When are payments due?
What happens if I don’t pay my monthly bill?
If I’m removed from the payment plan due to nonpayment, can I join again in the future?

Ayuda financiera

I have limited income and resources. What programs can help lower my drug costs?

Other questions

What if I need this information in another format or language?
How can I file a complaint or grievance about the payment plan?

Sharp Health Plan ofrece Sharp Direct Advantage. Sharp Health Plan es una HMO con un contrato de Medicare. La afiliación a Sharp Health Plan depende de la renovación del contrato. Lea el descargo de responsabilidad completo.

H5386_2025_Medicare Website_Rev 2

Última actualización de la página: 01/11/2024
  • 11/1/2024 6:42:57 a. m.
  • 11/1/2024 6:41:35 a. m.
  • 11/1/2024 6:42:57 a. m.
  • 1/1/0001 12:00:00 a. m.