One of the changes coming to the Medicare program in 2025 is the introduction of the Part D Prescription Payment Plan. This is the first time something like this has been implemented in the Medicare program, so many beneficiaries have questions. We’ll answer many of those questions today.
How Does the Prescription Payment Plan Work?
Medicare’s Prescriptions Payment Plan is a voluntary program that you will need to opt into each year, starting in 2025. It offers beneficiaries a way to manage out-of-pocket prescription costs that are covered by your Part D plan by extending payments throughout the calendar year.
The Prescription Payment Plan will apply to all Part D plans, as well as the prescription portion of any Medicare Advantage plans that include Part D coverage. There is no cost (and no interest incurred) if you decide to participate in the payment plan.
After you’ve opted into the program, you can decide which prescriptions you may need a payment plan for. When you pick up your prescription from the pharmacy, simply tell your pharmacist that you’d like to utilize the Part D Prescription Payment Plan. They will alert your Part D carrier, who will contact you to make payment arrangements.
Generally, this means an additional payment on top of your regular plan premium. You will pay the plan for your prescriptions, rather than your pharmacy. Payments could change monthly, since you may be adding your your balance over time. Adding a prescription to the plan earlier in the year will give you more time to make payments, and therefore lower your monthly payment, versus adding a prescription later in the year.
Remember, there will also be a new maximum out-of-pocket imposed on all Part D plans in 2025. The new out-of-pocket will be limited to $2000 for the calendar year.
How Do I Enroll in the Prescription Payment Plan?
You can enroll in the payment plan in several different ways. First, you can visit your plan’s website to get more information. You can also call the insurance carrier directly. You can do this as soon as you know what your new plan will be in 2025. If you decide to enroll later in the year, you may also choose to do so.
After you enroll in the payment plan, you’ll receive a letter confirming your participation. Any time you get a new prescription, the carrier will let the pharmacy know that you have a payment plan. Every month, the carrier will send you a separate bill for your prescriptions, along with information about how to make a payment.
If you do not make your payments on time, you will be automatically disenrolled from the payment program. Regardless, you will not be charged penalties or interest for failure to pay. You will not be terminated from your Part D or Medicare Advantage plan. One important thing to remember is that if you are struggling to make the payments, you should always make your premium payment first so that you do not lose your coverage.
You may choose to disenroll yourself from the prescription payment plan at any time, but you will still have to pay the balance on your account. You may make a single payment, or choose to continue to spread the payments out over the course of the calendar year.
If you change your plan during the year, you will need to contact your new carrier to re-enroll in the prescription payment plan.
