Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is more likely to help you if:

• You have high out-of-pocket expenses for prescriptions, especially those filled early in the year
• You fill a few high-cost prescriptions occasionally (rather than several low-cost ones regularly)
• You expect to reach your annual $2,100 out-of-pocket limit for prescriptions before September

Let’s take a look at some situations where the program probably would be useful:

Julie has a Part D prescription medicine she takes regularly that costs her $525 out of pocket each month (up to her annual out-of-pocket limit of $2,100). She crunched the numbers and decided that enrolling in the program at the beginning of the year would be a good idea. Turns out it was, as it better spread her costs out over the year:

Unlike Julie, Kent doesn’t take a regular prescription. However, he wanted to enroll in the program in case he had an emergency that required an expensive medicine. In March, he needed to spend $660 out of pocket on a prescription. That amount was then spread out over ten months, making him more able to manage his costs over the rest of the year.

The Medicare Prescription Payment Plan is less likely to help you if:

• Your out-of-pocket prescription expenses are low and fairly consistent
• You’re considering signing up for the program later in the year
• You don’t want to change how you pay for your prescriptions
• You get help paying for your prescriptions through another program

Let’s take a look at some situations where the program probably would not be useful:

Sheri pays $55 out of pocket each month for her prescriptions. That adds up to $660 each year – well under her annual $2,100 out-of-pocket maximum. Looking at what she would spend each month if she joined the program for the upcoming year, Sheri found out she’d end up with smaller payments early in the year but larger payments toward the end. Sheri wanted more consistency in her monthly budget, so she made the decision to keep her regular routine and pay for her prescriptions at the pharmacy.

Max has a Part D prescription medicine he takes regularly that costs him $525 out of pocket each month (up to his annual out-of-pocket limit of $2,100). However, he enrolled in his Medicare plan in September; if he also enrolled in the Medicare Prescription Payment Plan at that time, he would only have four months to spread out his costs. Compared to paying the pharmacy directly, he’d end up paying the same in September, less in October and November, but much more in December. This wasn’t right for Max’s budget, so he decided not to enroll in the program until the following year when he would have more months he could distribute his costs over.

If you’re not sure if you should enroll in the Medicare Prescription Payment Plan for your HealthPartners plan, you can get personalized advice based on your specific situation:

• In Minnesota, call Aging Pathways at 800-333-2433.
• In Wisconsin, call the State Health Insurance Assistance Program at 855-677-2783.

These no-cost, independent services are provided by the states of Minnesota and Wisconsin to help you make more informed Medicare decisions.

No. Signing up is optional and doesn’t affect your Part D prescription drug coverage benefits.

If you choose not to sign up, you’ll continue to pay for your prescriptions at the pharmacy according to your plan benefits.

No. The Medicare Prescription Payment Plan is not a discount program and doesn’t change your total out-of-pocket obligations for prescriptions through your HealthPartners Medicare Advantage or MSHO plan. At the end of the year, you’ll have paid the same amount of money for your medicines whether you enrolled in the program or not.

The benefit of the program is that it may distribute your prescription costs over time. For some, this can make paying for prescriptions more manageable and easier to budget.

Since the program doesn’t change what you ultimately pay for prescriptions, it’s still worth it to compare costs at different pharmacies. Sign in to compare drug prices at different pharmacy locations and options near you, or call the pharmacies you’re interested in for more information.

When you enroll in the program, all your covered Part D prescription drugs will be included in the Medicare Prescription Payment Plan. You can’t choose to enroll in the program for some prescriptions but not others.

If you have a balance due under the Medicare Prescription Payment Plan, you’ll receive a bill that comes from HealthPartners and our partner Express Scripts. When it arrives, pay the amount due by the indicated date.

It’s important to pay regularly and on time. If you become several months past due on your Medicare Prescription Payment Plan bills:

• Your participation in the program may be canceled, and you’ll be removed from the program. That means you’ll go back to paying for your prescriptions at the pharmacy. Program participation may be continued or reinstated if you have extenuating circumstances.
• You’ll continue to be billed for outstanding amounts you owe until they’ve been paid.
• You won’t lose your Medicare Part D prescription drug coverage (as long as you continue to pay your Medicare plan’s monthly premium, if any).

Note that if your HealthPartners Medicare plan has a monthly premium, the bills you receive for your premium will be separate from the bills you receive for the Medicare Prescription Payment Plan. Not all our plans have a monthly premium, but if yours does, always pay that bill first so you don’t lose your Medicare coverage. Bills for your HealthPartners Medicare plan premium will come solely from HealthPartners.

Yes, you can join the program retroactively, but only under these conditions:

• You couldn’t wait 24 hours for us to process your enrollment because you think your health, life or ability would be seriously jeopardized if you did; AND
• You requested enrollment within 72 hours of the date and time your urgent prescription claim was processed

If both conditions apply, you’ll be reimbursed for the prescription within 45 days, and we’ll add the cost to your Medicare Prescription Payment Plan balance (subject to monthly caps).

Yes. You can leave the program at any time. If you do, you’ll continue to receive bills for amounts you owe while you were enrolled in the program. Moving forward, you’ll pay your pharmacy directly for any new prescriptions, according to your plan benefits.

To leave the program, call 866-845-1803 (TTY 800-716-3231).

If you leave or change your HealthPartners Medicare Advantage or MSHO plan while you still have a balance due, you’ll continue to receive bills for amounts you owe under the program. However, you won’t have to pay the balance all at once – these bills will continue to be capped each month.

If you move to a new Medicare Advantage plan, MSHO plan or other plan that offers Part D prescription drug coverage, you can also enroll in the program under that Medicare plan. All Medicare plans that offer prescription drug coverage are required to offer the Medicare Prescription Payment Plan – contact your new plan if you’d like to participate again.

No. Once you sign up for the program, annual re-enrollment is automatic until you request to leave the program or you leave your HealthPartners Medicare plan entirely.

Generally, the Medicare Extra Help program offers more advantages than the Medicare Prescription Payment Plan. Through the Extra Help program, you may receive substantial assistance with your drug costs, while the Prescription Payment Plan does not offer any discounts.

Our Medicare determinations, appeals and grievances page has step-by-step instructions on how to file a complaint (grievance).