What is the Medicare Prescription Payment Plan?
The Medicare Prescription Payment Plan is a new 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).
Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary and free.
To learn more click here – “What’s the Medicare Prescription Payment Plan – Centers for Medicare and Medicaid Q&A”
Will This Help Me?
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. Answer a few questions to find out if this payment option is likely to help you.
This payment option may not be the best choice for you if:
Your yearly drug costs are low.
- Your drug costs are the same each month.
- You’re considering signing up for the payment option late in the calendar year (after September).
- You don’t want to change how you pay for your drugs.
- You get or are eligible for Extra Help from Medicare.
- You get or are eligible for Medicare Savings Program.
- You get help paying for your drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP), a coupon program, or other health coverage.
The Medicare Prescription Payment Plan is a new payment option that works with your current drug coverage, and it can help you manage your drug costs by spreading them across monthly payments that vary throughout the year (January – December). This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs. “Extra Help” from Medicare and help from your SPAP and ADAP, for those who qualify, is more advantageous than participation in the Medicare Prescription Payment Plan.
How does it work?
When you fill a prescription for a drug covered by Part D, you won’t pay your pharmacy (including mail order and specialty pharmacies). Instead, you’ll get a bill each month from RiverSpring Health Plans.
Even though you won’t pay for your drugs at the pharmacy, you’re still responsible for the costs. If you want to know what your drug will cost before you take it home, call us, or ask the pharmacist.
How is my monthly bill calculated?
Your monthly bill is based on what you would have paid for any prescriptions you get, plus your previous month’s balance, divided by the number of months left in the year. All plans use the same formula to calculate your monthly payments. Review examples of how this payment option works in different situations.
Or click on this link to use the calculator if you want to get an estimate of what you will pay for your drug Calculator.
Your payments might change every month, so you might not know what your exact bill will be ahead of time. Future payments might increase when you fill a new prescription (or refill an existing prescription) because as new out-of-pocket costs get added to your monthly payment, there are fewer months left in the year to spread out your remaining payments.
In a single calendar year (January – December), you will never pay more than:
- The total amount you would have paid out of pocket to the pharmacy if you were not participating in this payment option.
- The out-of-pocket maximum for prescription drugs that are covered by your plan ($2,000 in 2025).
The prescription drug law caps your out-of-pocket drug costs for covered drugs at $2,000 in 2025. This is true for everyone with Medicare drug coverage, even if you don’t participate in the Medicare Prescription Payment Plan.
How do I sign up?
- In 2024, for 2025:If you want to participate in the Medicare Prescription Payment Plan for 2025, contact us at 1-866-845-1803, TTY 1-800-716-3231 Calls to these numbers are free. Call hours are 24 hours a day, 7 days a week. Or you can click on this link to Enroll Your participation will start January 1, 2025.
- During 2025: Starting January 1, 2025, you can contact us at 1-866-845-1803, TTY 1-800-716-3231 Calls to these numbers are free. Call hours are 24 hours a day, 7 days a week. Or you can click on this link to Enroll electronically to start participating in the Medicare Prescription Payment Plan anytime during the calendar year.
Remember, this payment option may not be the best choice for you if you sign up late in the calendar year (after September). This is because as new out-of-pocket drug costs are added to your monthly payment, there are fewer months left in the year to spread out your payments.
You can leave the Medicare Prescription Payment Plan at any time by contacting RiverSpring Health Plans at 1-866-845-1803, TTY 1-800-716-3231. Leaving won’t affect your Medicare drug coverage and other Medicare benefits. Keep in mind:
- If you still owe a balance, you’re required to pay the amount you owe, even though you’re no longer participating in this payment option.
- You can choose to pay your balance all at once or be billed monthly.
- You’ll pay the pharmacy directly for new out-of-pocket drug costs after you leave the Medicare Prescription Payment Plan.
How do I File a Grievance?
Your health and satisfaction are important to us. When you have a problem or concern, please first call RiverSpring HealthPlans at 1-800-771-0088 (TTY/TDD: 711). Our member service staff will work with you to try and find a satisfactory solution to your problem.
You can also contact us to ask about the grievance and appeal process, or the status on the processing of your grievance or appeal, or for information on the total number of grievances, appeals and exceptions filed with RiverSpring