Anyone with a Medicare Part D prescription drug plan (Including Medicare Advantage plans with drug coverage) is eligible to opt in to the Medicare Prescription Payment Plan. This program is optional and you must opt in to participate.

While this program is available to anyone with Medicare Part D, it may be particularly helpful if you use medications with high out-of-pocket costs (such as branded or specialty drugs) and are likely to reach the $2,000 out-of-pocket spending cap earlier in the year.

Instead of paying the pharmacy for your prescriptions, you will pay your plan over the year in capped monthly installments. Your maximum monthly payments will be calculated based on what you have spent toward the $2,000 out-of-pocket limit and the number of remaining months In the plan year.

You can opt in during Medicare open Enrollment or any time in 2025. Opting in early is recommended. Until you are enrolled, you will continue to pay your full copay amount when the prescription is filled instead of smoothing out the payments over the full year.

You will only be billed for what you spend toward the out-of-pocket cap and do not have to reach or pay the full $2,000 limit as a condition of participating in the program.

There is no cost to participate in the Medicare Prescription Payment Plan.

All drugs covered by your Part D plan (including specialty, branded, and generic) qualify toward your annual out-of-pocket costs and will be billed as part of your monthly installment benefit until you reach the $2,000 spending cap.

The Extra Help program reduces qualifying members' total out-of-pocket drug costs, whereas the Medicare Prescription Payment Plan helps “smooth” these costs into more manageable monthly payments Instead of a lump sum early in the year. For more information about the Extra Help program, please call 1-800-772-1213 or visit www.ssa.gov/extrahelp.

To learn more, please call your plan or visit your plan's website. Additional information. Including a preview of your estimated monthly and annual costs, can be found here or by calling 1-S00-MEDICARE (1.800-633-4227). TTY users can call 1-877-486-2048.