Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan, available in 2025, allows the distribution of Part D medication costs throughout the year. Participation is voluntary.
What is the medicare prescription payment plan?
The Medicare Prescription Payment Plan is a new payment option under the Prescription Drug Act that works with your existing drug coverage to help you manage your Medicare Part D costs by spreading them out over the calendar year (January through December). Starting in 2025, anyone with a Medicare drug plan or a Medicare health plan with drug coverage (such as a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option, and participation is voluntary.
If you choose this payment option, you will continue to pay MMM your premium (if you have one) each month, and you will receive a bill from your health or drug plan to pay for your prescription drugs (instead of paying at the pharmacy). There is no cost associated with participating 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 your health or drug plan.
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 MMM at (866) 333-5470 or ask the pharmacist.
This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. Go to the section “What programs can help lower my costs?” to learn about Extra Help and other programs that might save you money, if you qualify.
Know that, if we fail to process your request within the stipulated time (i.e., within 24 hours of the individual providing the requisite information for election into the program), we must process a retroactive election and reimburse you any out-of-pocket cost sharing paid on or after that date and include those amounts, as appropriate, in a monthly bill under the program within 45 days.
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.
Please refer to the examples at the end of this page for how your monthly bill is calculated.
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’ll never pay more than:
- The total amount you would have paid out of pocket to the pharmacy if you weren’t participating in this payment option.
- The Medicare drug coverage annual out-of-pocket maximum ($2,000 in 2025).
The prescription drug law caps your out-of-pocket drug costs 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.
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.
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 a 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.
- MMM: Visit the MMM website or call MMM at 833-696-2087 (TTY – 711) Monday through Sunday, 8:00 a.m. to 8:00 p.m. EST, to get more information. If you need to pick up a prescription urgently, call MMM at (866) 333-5470 (TTY – 711) Monday through Sunday, 8:00 a.m. to 8:00 p.m., to discuss your options.
- Medicare: Visit Medicare.gov/prescription-payment-plan to learn more about this payment option and if it might be a good fit for you.
- State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling.
Visit the MMM website Activate.RxPayments.com, or call MMM at (833) 696-2087 (TTY – 711) to start participating in this payment option:
- In 2024, for 2025: If you want to participate in the Medicare Prescription Payment Plan for 2025, contact MMM at 833-696-2087 (TTY – 711) Monday through Sunday, 8:00 a.m. to 11:00 p.m. EST. Your participation will start January 1, 2025.
- During 2025: Starting January 1, 2025, you can contact us at 833-696-2087 (TTY – 711) Monday through Friday, 8:00 a.m. to 8:00 p.m. EST, 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.
What happens after I sign up?
Once MMM reviews your participation request, we will send you a letter confirming your participation in the Medicare Prescription Payment Plan. Then:
- When you get a prescription for a drug covered by Part D, MMM will automatically let the pharmacy know that you’re participating in this payment option, and you won’t pay the pharmacy for the prescription. 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 MMM at (866) 333-5470 (TTY – 711) Monday through Sunday, 8:00 a.m. to 8:00 p.m., or ask the pharmacist.
- Each month, MMM will send you a bill with the amount you owe for your prescriptions, when it’s due, and information on how to make a payment. You’ll get a separate bill for your monthly plan premium (if you have one).
After MMM approves your participation in the Medicare Prescription Payment Plan, you’ll get a letter from MMM with information about how to pay your bill.
Online
Through the mail
Echo Health, Inc.
PO Box 5730
Carol Stream, IL 60197-5730
For overnight / courier (FedEx/UPS) delivery
Echo Health, Inc-595730
270 Remington Blvd, Suite B
Bolingbrook, IL 60440
You’ll get a reminder from MMM if you miss a payment. If you don’t pay your bill by the date listed in that reminder, you’ll be removed from the Medicare Prescription Payment Plan. You’re required to pay the amount you owe, but you won’t pay any interest or fees, even if your payment is late. You can choose to pay that amount all at once or be billed monthly. If you’re removed from the Medicare Prescription Payment Plan, you’ll still be enrolled in MMM.
Always pay your health or drug plan monthly premium first (if you have one), so you don’t lose your drug coverage. If you’re concerned about paying both your monthly plan premium and Medicare Prescription Payment Plan bills, go to the section “What programs can help lower my costs?” for information about programs that can help lower your costs.
Call MMM at (833) 696-2087 (TTY – 711) Monday through Friday, 8:00 a.m. to 8:00 p.m. EST, if you think MMM made a mistake about your Medicare Prescription Payment Plan bill. If you think MMM made a mistake, you have the right to follow the grievance process found in your Member Handbook or Evidence of Coverage.
You can leave the Medicare Prescription Payment Plan at any time by contacting MMM at 833-696-2087 (TTY – 711) Monday through Friday, 8:00 a.m. to 8:00 p.m. EST. 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.
If you leave MMM or change to a new Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage), your participation in the Medicare Prescription Payment Plan will end.
Contact your new plan if you’d like to participate in the Medicare Prescription Payment Plan again.
If you have limited income and resources, find out if you qualify for one of these programs:
- Extra Help: A Medicare program that helps pay your Medicare drug costs. 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.
- Medicare Savings Programs: State-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance. Visit Medicare.gov/medicare-savings-programs to learn more.
- State Pharmaceutical Assistance Programs (SPAPs): Programs that 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.
- Manufacturer Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs, PAPs): Programs from drug manufacturers to help lower drug costs for people with Medicare. Visit go.medicare.gov/pap to learn more.
Many people qualify for savings and don’t realize it. Visit Medicare.gov/basics/costs/help, or contact your local Social Security office to learn more. Find your local Social Security office at ssa.gov/locator/.
- MMM: Visit the MMM website or call your plan to get more information.
- Medicare: 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.
Medicare Prescription Payment Plan — Contact Information
| CALL | 833-696-2087 (TTY – 711) 8:00 a.m. – 8:00 p.m. EST Monday through Friday During AEP – 8:00 a.m. – 11:00 p.m. EST 7 days a week Calls to this number are free. |
|---|---|
| TTY | 833-696-2087 (TTY – 711) 8:00 a.m. – 8:00 p.m. EST Monday through Friday During AEP – 8:00 a.m. – 11:00 p.m. EST 7 days a week Calls to this number are free. |
| FAX | 440-557-6525 |
| WRITE | MMM Mailstop: 1003 MPPP Election Dept. 13900 N. Harvey Ave Edmond, OK 73013 Email: ElectMPPP@RxPayments.com |
| WEBSITE | Activate.RxPayments.com |
Examples of how a monthly bill is calculated
You take several high-cost drugs that have a total out-of-pocket cost of $500 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill differently than your bill for the rest of the months in the year. First, we figure out your “maximum possible payment” for the first month:
Then, we figure out what you’ll pay for January:
- Compare your total out-of-pocket costs for January ($500) to the “maximum possible payment” we just calculated: $166.67.
- Your plan will bill you the lesser of the two amounts. So, you’ll pay $166.67 for the month of January.
- You have a remaining balance of $333.33 ($500 − $166.67).
For February and the rest of the months left in the year, we calculate your payment differently:
We’ll calculate your March payment like we did for February:
In April, when you refill your prescriptions again, you’ll reach the annual out-of-pocket maximum for the year ($2,000 in 2025). You’ll continue to pay what you already owe and get your prescription(s), but after April you won’t add any new out-of-pocket costs for the rest of the year:
Even though your payment varies each month, by the end of the year you’ll never pay more than: the total amount you would have paid out of pocket, or the total annual out-of-pocket maximum ($2,000 in 2025). Remember, this is just your monthly payment for your out-of-pocket drug costs; you still need to pay your health or drug plan’s premium (if you have one) each month.
| Month | Your drug costs (without this option) | Your monthly payment (with this option) | Notes |
|---|---|---|---|
| January | $500 | $166.67 | This is when you started participating in this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently. |
| February | $500 | $75.76 | |
| March | $500 | $125.76 | |
| April | $500 | $181.31 | This month you reached the annual out-of-pocket maximum ($2,000 in 2025). You’ll have no new out-of-pocket drug costs for the rest of the year. |
| May | $0.00 | $181.31 * | |
| June | $0.00 | $181.31 * | |
| July | $0.00 | $181.31 * | |
| August | $0.00 | $181.31 * | |
| September | $0.00 | $181.31 * | |
| October | $0.00 | $181.31 * | |
| November | $0.00 | $181.31 * | |
| December | $0.00 | $181.31 * | |
| Total | $2,000.00 | $2,000.00 | You’ll pay the same total amount for the year, even if you don’t use this payment option. |
* You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe.
If you’re concerned about paying $500 each month from January to April, this payment option will help you manage your costs. If you prefer to pay $500 each month for 4 months and then pay $0 for the rest of the year, this payment option might not be right for you. Contact your health or drug plan for personalized help.
You take several drugs that have a total out-of-pocket cost of $80 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill differently than your bill for the rest of the months in the year. First, we figure out your “maximum possible payment” for the first month:
Then, we figure out what you’ll pay for January:
- Compare your total out-of-pocket costs for January ($80) to the “maximum possible payment” we just calculated: $166.67.
- Your plan will bill you the lesser of the two amounts. So, you’ll pay $80 for the month of January.
- You have a remaining balance of $0.
For February and the rest of the months left in the year, we calculate your payment differently:
We’ll calculate your March payment like we did for February:
Even though your payment varies each month, by the end of the year you’ll never pay more than: the total amount you would have paid out of pocket, or the total annual out-of-pocket maximum ($2,000 in 2025). Remember, this is just your monthly payment for your out-of-pocket drug costs; you still need to pay your health or drug plan’s premium (if you have one) each month.
| Month | Your drug costs (without this option) | Your monthly payment (with this option) | Notes |
|---|---|---|---|
| January | $80.00 | $80.00 | This is when you started using this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently. |
| February | $80.00 | $7.27 | |
| March | $80.00 | $15.27 | |
| April | $80.00 | $24.16 | |
| May | $80.00 | $34.16 | |
| June | $80.00 | $45.59 | |
| July | $80.00 | $58.93 | |
| August | $80.00 | $74.92 | |
| September | $80.00 | $94.93 | |
| October | $80.00 | $121.59 | |
| November | $80.00 | $161.59 | |
| December | $80.00 | $241.59 | |
| Total | $960.00 | $960.00 | You’ll pay the same total amount for the year, even if you don’t use this payment option. |
Depending on your specific circumstances, you might not benefit from using this payment option due to the higher payments that start in September. Contact your health or drug plan for personalized help.
You pay $4 every month in out-of-pocket costs for a prescription you use regularly. In April 2025, you need a new one-time prescription that costs $613, so your total out-of-pocket costs in April are $617. That same month, before you fill your prescriptions, you decide to participate in the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill differently than your bill for the rest of the months in the year. First, we figure out your “maximum possible payment” for the first month:
Then, we figure out what you’ll pay for April:
- Compare your total out-of-pocket costs for April ($617) to the “maximum possible payment” we just calculated: $220.89.
- Your plan will bill you the lesser of the two amounts. So, you’ll pay $220.89 for the month of April.
- You have a remaining balance of $396.11 ($617 − $220.89).
For May and the rest of the months left in the year, we calculate your payment differently:
Your payments will vary throughout the year. That’s because you’re adding drug costs during the year, but you have fewer months left in the year to spread your payments across. By the end of the year you’ll never pay more than: the total amount you would have paid out of pocket, or the total annual out-of-pocket maximum ($2,000 in 2025). Remember, this is just your monthly payment for your out-of-pocket drug costs; you still need to pay your health or drug plan’s premium (if you have one) each month.
| Month | Your drug costs (without this option) | Your monthly payment (with this option) | Notes |
|---|---|---|---|
| January | $4.00 | $4.00 * | |
| February | $4.00 | $4.00 * | |
| March | $4.00 | $4.00 * | |
| April | $617.00 | $220.89 | This is when you started using this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently. |
| May | $4.00 | $50.01 | |
| June | $4.00 | $50.59 | |
| July | $124.00 | $71.25 | This month, you need a drug that’s $120, in addition to your $4 drug. Following the same formula we used in May, your payments increase because you’re adding drug costs during the year, but you have fewer months left in the year to spread your payments across. |
| August | $4.00 | $72.05 | |
| September | $4.00 | $73.05 | |
| October | $124.00 | $114.39 | This month, you need a drug that’s $120, in addition to your $4 drug. Following the same formula we used in May, your payments increase because you’re adding drug costs during the year, but you have fewer months left in the year to spread your payments across. |
| November | $4.00 | $116.39 | |
| December | $4.00 | $120.38 | |
| Total | $901.00 | $901.00 | You’ll pay the same total amount for the year, even if you don’t use this payment option. |
* You made these payments directly to the pharmacy before you started participating in the Medicare Prescription Payment Plan.
If you’re concerned about paying $617 in April, this payment option will help you spread your costs across monthly payments that vary throughout the year. If you’re concerned about higher payments later in the year, this payment option might not be right for you. Contact your health or drug plan for personalized help.