The Medicare Prescription Payment Plan is a voluntary payment option offered to all members, regardless of income level and is offered by all Medicare insurers with Part D plans. There are no fees or interest charges associated with the program. Participation in the plan does not reduce the amount you owe for your Part D prescriptions. Your cost-sharing responsibilities remain the same, but payment is more flexible.

• You will continue to pay your Medicare Part D plan premium as usual. Always pay your monthly premium first to maintain your drug coverage.

• If you enroll in the Medicare Prescription Payment Plan in 2025 for coverage in 2026, your participation will begin on January 1, 2026. You can sign up at any time during the year. 
• Once approved, you’ll receive a letter with instructions on how to manage your payments. When a pharmacy submits a claim for your prescription, they will be notified that you’re using this payment option, and they should be processing claims to the Medicare Prescription Payment Plan.
• Instead of paying your drug costs at the pharmacy (including mail order and specialty pharmacies), you’ll receive a monthly bill based on the cost of your prescriptions and any outstanding balance, divided by the number of months remaining in the year. For details on how drug payments are calculated, refer to the “What’s the Medicare Prescription Payment Plan?” Fact Sheet in the Addition Resources section below.
• You remain responsible for all out-of-pocket costs for Medicare Part D drugs.     

Timely payment of your monthly bills is crucial. Failure to make payments on time can result in:

• Termination of Coverage in the Medicare Prescription Payment Plan: Persistent non-payment will cause your coverage in the payment option to be involuntary terminated and will not be able to opt back into the payment plan until your balance is paid.
• Pharmacy Claims Processing: You will begin to pay for your Medicare Part D prescription costs at the pharmacy if you are involuntary terminated.

• "Extra Help" from Medicare and help from your State Pharmaceutical Assistance Program (SPAP) and ADAP, for those who qualify, is more advantageous than participation in the Medicare Prescription Payment Plan.
• Extra Help is a financial assistance program for Medicare beneficiaries with limited income and resources. It helps cover costs associated with Medicare Part D, including monthly premiums, copays, and coinsurance.
  • Visit ssa.gov/medicare/part-d-extra-help to find out if you qualify and apply. You can also apply with your State Medical Assistance (Medicaid) office. Visit Medicare.gov/ExtraHelp to learn more.
• For free, personalized health insurance counseling, visit shiphelp.org to find the contact information for your local State Health Insurance Assistance Program (SHIP).
• SPAP Programs might include coverage for your Medicare drug plan premiums and/or cost sharing. SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit. Visit go.medicare.gov/spap to learn more.

Visit https://m3p-form.optumrx.com/?cid=SHPM3P to start your request or call 1-877-998-0998 TTY: 711.

Download Form

Mail your participation request form to the address listed at the bottom of the form.

When you opt out of the Medicare Prescription Payment Plan, the following will occur:

• You will start paying your pharmacy directly for all covered Part D drug costs, including those from mail order and specialty pharmacies.
• Part D drug costs will no longer be added to your monthly bill balance. 
• You will continue to receive monthly bills for any remaining balance accrued while you were in the program until it is fully paid. 
• You can choose to pay off the balance in full at any time.
• If you decide to rejoin the program in the future, you can opt-in again as you did before.

Yes, your participation in the Medicare Prescription Payment Plan ends on December 31 if you choose to change your Part D plan. To continue with the program in the new plan year under your new Part D plan, you must re-enroll for a January 1 start date.

If you are participating in the Medicare Prescription Payment plan and remain in the same Part D plan, your participation in the payment plan will automatically continue in the new plan year.  You will receive an automatic renewal notice before the start of the new year informing you of your participation in the payment plan and instructions on how to opt out if you want to.

Urgent requests for the Medicare Prescription Payment Plan can be made under certain circumstances. If you face an urgent need due to financial hardship or unexpected medical expenses, call Customer Service at 1-877-998-0998 TTY: 711.

If you experience issues or disagree with our decision on the Medicare Prescription Payment Plan, You or your appointed representative can call 1-877-998-0998 (TTY: 711) to file a grievance or complaint. For more on this process, refer to Chapter 9 “If you have a problem or complaint (coverage decisions, appeals, complaints)” in your Evidence of Coverage.

Visit Medicare.gov/prescription-payment-plan or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048 for additional information.

You can also review Medicare’s “What’s the Medicare Prescription Payment Plan?” Fact Sheet for more information.