The Medicare Prescription Payment Plan is a new payment option created under the Inflation Reduction Act that requires Part D plan sponsors to provide their enrollees with the option to pay out-of-pocket prescription drug costs in the form of monthly payments over the course of the plan year instead of all at once to the pharmacy. The program begins on January 1, 2025. Program participants will pay $0 to the pharmacy for covered Part D drugs, and Part D plan sponsors will then bill program participants monthly for any cost sharing they incur while in the program. Pharmacies will be paid in full by the Part D sponsor in accordance with Part D prompt payment requirements.

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Medicare Prescription Payment Plan Participation Request Form:

To Opt In you can either:

Examples of program calculations:

Please review the Medicare Prescription Payment Plan Fact sheet for detailed examples and more information about the program: https://www.medicare.gov/publications/12211-whats-the-medicare-prescription-payment-plan.pdf

Who is likely to benefit from this program:

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 (before September), gives you more months to spread out your drug costs.

Financial Implications and paying monthly bills:

  • This program is free to join.
  • There are no fees or interest charged under this program
  • This program does not reduce the amount of cost sharing a participate owes for their Part D prescriptions.
  • In 2025 you won’t pay more than $2,000 for out-of-pocket Part D covered drug costs. This is true for all who have Medicare drug coverage, even if you haven’t joined the Medicare Prescription Payment Plan. The Medicare Prescription Payment Plan simply spreads your costs during the year. Your monthly bill will be 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 plan year.
  • It is important to make timely payments. Your Medicare Prescription Payment Plan terminates if payments are not received within two (2) months of their due date.

How to Opt IN or OUT of the program:

  • Opt In: To Opt In fill out the request form here, call or email Nascentia Health Plus to let us know you want to opt in to the program. See Contact information section below for our phone number, address and email.
  • Opt Out: You may opt-out of the program if you no longer want to be enrolled. Call our Team at 1-888-477-0090 (TTY: 711).

Note: If you owe a balance, you still need to pay it! Even though you’re no longer in the Payment Plan program you must pay the balance you owe. Don’t forget, once you leave the program, you will pay the pharmacy directly for new out-of-pocket drug costs.

Timing of Opt In:

Requests made for the upcoming plan year, your application will be processed within 10 calendar days of receipt. Or, it will be processed the number of calendar days before the plan enrollment starts – whichever time period is shorter. You will be alerted if you are approved or denied electronically and/or by mail.

If we need more information to process your request, you will receive notice from your Part D plan within the same timeframe stated above.

Note: If you request to opt-in to the Medicare Prescription Payment Plan during the plan year, your request will be processed within 24 hours. If more information is needed to process the request, Nascentia Health Plus will make efforts to collect the needed information.

Information on filing complaints and grievances related to this program:

Contact information:

General Information about Low-Income Subsidy Program (LIS): Extra Help: The Extra Help program helps people who have modest income and resources to pay Medicare prescription drug program costs. Costs such as:

Premiums, Deductibles, Prescription cost shares. You may qualify for Extra Help based on your income and resources. Beginning in 2024, the program expanded to cover more drug costs for people with modest resources – those who earn less than 150% of the federal poverty level.

To find out if you qualify for Extra Help, call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) Monday through Friday, between 8 a.m. and 7 p.m. local time. You can also apply at your local Social Security Office or online through the Social Security Administration (https://www.ssa.gov/medicare/part-d-extra-help).

Last Updated on January 14, 2025