Medicare Prescription Payment Plan

In 2027, you will not pay more than $2,400 for out-of-pocket Part D covered drug costs. This is true for all who have Medicare drug coverage, even if you do not join the payment plan.

Your monthly bill is based on:

• Your current balance
• The number of months left in the year

If you fill new prescriptions, those costs are added to your balance. Your monthly bill may change.

Example: How your monthly Medicare Prescription Payment Plan bill is calculated

This example shows how the payment plan works over time and how your monthly bill may change during the year.

January

• You sign up for the payment plan
• You fill a prescription that costs $600
• There are 12 months left in the year
• Your monthly bill is $50 ($600 divided by 12)

February

• You don't fill any new prescriptions
• You pay your monthly bill of $50
• Your remaining balance is $550 ($600 - $50)

March

• You fill another prescription that costs $300
• Your new balance is $850 ($550 + $300)
• There are 10 months left in the year
• Your new monthly bill is $85 ($850 divided by 10)
• You pay your monthly bill of $85
• Your remaining balance is $765 ($850 - $85)

For more details and examples, please review the fact sheets below:

• Medicare Prescription Payment Plan Fact Sheet - English (PDF)
• Medicare Prescription Payment Plan Fact Sheet - Spanish (PDF)

Yes, you can use the payment plan at retail, mail-order, or specialty pharmacies.

Please be sure to tell your pharmacy that you are enrolled in the Medicare Prescription Payment Plan before they process your prescription(s).

If you sign up before your Part D coverage starts for the new plan year, we will process your request within 10 calendar days after we receive it or before your coverage start date, whichever comes first. We will let you know by mail and/or electronically if your request is approved or denied.

If we need more information to process your request, your Part D plan will contact you within that same timeframe.

Note: If you sign up during the plan year, we will process your request within 24 hours. If we need more information, your Part D plan will contact you as quickly as possible.

Sometimes, an urgent election may let you join the Medicare Prescription Payment Plan after you have already received a prescription.

If you think a delay in filling your covered prescription may harm your life, health, or ability to regain maximum function, please call us at 1-833-750-9969 (TTY: 1-800-716-3231) to talk about your options.

• You can pay via check, electronic funds transfer or credit card.
• You can also set up automatic monthly payments for the amount you owe.
• Important: You must pay your bill on time. You may be removed from the payment plan if your payments are more than two months late.

• Any unpaid amount from prior monthly bills is added to your new billing statement.
• It is important to pay on time. Your Medicare Prescription Payment Plan will end if payments are not received within two (2) months of their due date.

Maybe. This plan can help you spread your drug costs across monthly bills, but it does not lower your total costs or save you money.

The plan may work best for you if:

• Your drug costs are high earlier in the year
• You want to spread those costs over time

You can join the payment plan at any time. But joining earlier in the year, such as before September, gives you more months to spread out your costs.

Visit the Medicare Prescription Payment Plan website to answer a few questions and learn if this option may be right for you.

This payment plan may not be right for you if:

• You have low drug costs.
• You have the same costs each month.
• You prefer to pay at the pharmacy.
• You are joining late in the year (after September).
• You qualify for Extra Help or other assistance programs, such as a Medicare Savings Program, State Pharmaceutical Assistance Program (SPAP), or a charity.

You can join the payment plan in any of these ways:

• Online: Visit the Medicare Prescription Payment Plan Portal.
• Phone: Call Member Services at 1-833-750-9969 (TTY: 1-800-716-3231), available 24 hours a day, 7 days a week, to enroll in this payment plan.
• By mail:
  • Complete and return the Medicare Prescription Payment Plan Enrollment Form - English (PDF).
  • Complete and return the Medicare Prescription Payment Plan Enrollment Form - Spanish (PDF).

You can cancel the payment plan at any time if you no longer want to take part.

Visit our Medicare Prescription Payment Plan Portal or call 1-833-750-9969 (TTY: 1-800-716-3231), available 24 hours a day, 7 days a week.

Note: If you still owe money, you must still pay that amount. After you leave the payment plan, you will pay the pharmacy directly for new out-of-pocket drug costs.

You can file a grievance by mail or fax:

Wellcare By Fidelis Care
Attn: Member Services Department
25-01 Jackson Ave.
Long Island City, NY 11101-5095

Fax: 1-877-533-2402

Please be sure to include your Part D plan Member ID to ensure timely review.

Yes. Other programs may help lower your drug costs. They include:

• Extra Help: This program helps people with limited income and resources pay Medicare prescription drug costs, including:
  • Premiums
  • Deductibles
  • Prescription cost shares

You may qualify for Extra Help based on your income and resources. Beginning in 2024, the program expanded to help more people with modest resources by covering more drug costs for people 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.

If you qualify for Extra Help, it may help you more than joining the Medicare Prescription Payment Plan.

• Medicare Savings Programs: These state-run programs might help you pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance. Visit the Medicare.gov website to learn more.
• State Pharmaceutical Assistance Programs (SPAPs): These programs may help pay your Medicare drug plan premiums and/or cost sharing. SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit. Visit the SPAP website to learn more.
• Manufacturer Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs)): These programs from drug manufacturers may help lower drug costs for people with Medicare. Visit the PAPs website to learn more.