The Medicare Prescription Payment Plan is a payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January–December). This payment option is free to those who opt in. All plans offer this payment option and participation is voluntary.
For example, if you need a specialty drug at the beginning of the year and your cost share is more than $2,000, this program will spread payments out at $166.76 per month, rather than you paying the total $2,000 expense all at once.
It is important to note, each member who opts into this program may have different payments. How is that possible? Each prescription and its associated costs can alter a member's monthly Medicare Prescription Payment Plan payment. Since each member may need different medications - it is possible that no two member's monthly payments will be identical.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
You take several high-cost drugs that have a total out-of-pocket cost of $500 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
You take several drugs that have a total out-of-pocket cost of $80 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
You pay $4 every month in out-of-pocket costs for a prescription you use regularly. In April 2025, you need a new one-time prescription that costs $613, so your total out-of-pocket costs in April are $617. That same month, before you fill your prescriptions, you decide to participate in the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
Even though your payment may vary each month, by the end of the year, you’ll never pay more than:
It depends on your situation. Remember, this payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.
You’re most likely to benefit from participating in the Medicare Prescription Payment Plan if you have high drug costs earlier in the calendar year. Although you can start participating in this payment option at any time in the year, starting earlier in the year (like before September), gives you more months to spread out your drug costs. Go to Medicare.gov/prescription-payment-plan/will-this-help-me to answer a few questions, and find out if you’re likely to benefit from this payment option.
This payment option may not be the best choice for you if:
You’ll get a reminder from us if you miss a payment. If you don’t pay your bill by the date listed in that reminder, you’ll be removed from the Medicare Prescription Payment Plan. You’re required to pay the amount you owe, but you won’t pay any interest or fees, even if your payment is late. You can choose to pay that amount all at once or be billed monthly. If you’re removed from the Medicare Prescription Payment Plan, you’ll still be enrolled in your SummaCare Medicare plan.
Always pay your health or drug plan monthly premium first (if you have one), so you don’t lose your drug coverage.
The timing of processing your request depends on when your request is received.
If you elect into the Program prior to the plan year, we will process your election request within 10 calendar days of receipt or within the calendar days before your plan enrollment starts, whichever is shorter. We will confirm enrollment into your SummaCare Medicare Plan with CMS, before processing your request into the Medicare Prescription Payment Plan.
If you elect into the Program during the plan year, we will process your election request within 24 hours.
If you meet certain conditions, we may process an Urgent Medicare Prescription Payment Plan Election
An urgent retroactive election may be necessary if you have certain urgent prescription fill(s) for which you may pay the associated cost sharing before your program election request was received and processed. An urgent retroactive request will be processed if both the following conditions are met:
You can leave the Medicare Prescription Payment Plan at any time by calling us at 330.996.8885 or toll free at 800.996.6250 (TTY 711). Leaving won’t affect your Medicare drug coverage and other Medicare benefits. Keep in mind:
Information about how to file a complaint, grievance or appeal regarding the Medication Prescription Payment Plan can be found here
For More information regarding the Medicare Prescription Payment Plan you can: