Medicare Prescription Payment Plan

For members with a Medicare Part D plan

Starting 2025, the Medicare Prescription Payment Plan will be available to all beneficiaries with a Medicare Part D plan. This is a program that works with your Medicare Part D drug coverage to help you manage your out-of-pocket pharmacy costs by spreading them over the plan year.

Note: The Medicare Prescription Payment Plan doesn’t reduce the amount of cost-sharing owed for Part D prescriptions. You won't pay more than the maximum out-of-pocket (MOOP) costs of $2,000 for 2025 regardless of your participation in the Medicare Prescription Payment Plan.

Election into this program is voluntary and free to join, with no additional fees or interest. Each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill to pay for your prescription drugs (instead of paying the pharmacy).

If you think you'll benefit from the Medicare Prescription Payment Plan, you can enroll.

Learn more about the Medicare Prescription Payment Plan by downloading the CMS fact sheet

CMS Fact sheet (English) (PDF)
CMS Fact Sheet (Spanish) (PDF)

How does it work?

When you fill a prescription under the Medicare Prescription Payment Plan, you won't pay your pharmacy (including mail order and specialty pharmacies). Instead, you'll get a bill each month.

Even though you won't pay for your drugs at the pharmacy, you’re still responsible for the costs. Each month, you will receive a bill with the amount you owe for your prescriptions, when it’s due, and information on how to make a payment. You'll continue to be responsible for your monthly plan premium (if you have one). 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.

Is the Medicare Prescription Payment Plan a good fit for me?

Do you have high out-of-pocket costs earlier in the year? Or is your out-of-pocket cost more than $600 for any single Part D medication? Would spreading out your costs across the remainder of the year help manage your monthly drug costs? If so, you might consider electing into the program.

 Examples of how the program will work and how monthly payments would be calculated

If you are still unsure, use a calculator to look at your specific out-of-pocket costs and see if this program will be right for you. 

You can call SimplicityRx's member services team at 1-833-696-2087 (TTY: 711), 7 a.m. - 12 a.m. CT (7 days a week from Oct. 15 - Dec. 7), otherwise, 7 a.m. - 10 p.m. CT (Monday - Friday).

If you have questions about if this payment option will help, you can find more information at Medicare.gov.

What happens if I don't pay my bill?

When you elect in the program, you will not pay at the pharmacy, instead you will get a monthly bill. You'll be able to pay your monthly bill by credit card, check, or debit.

We will send you several reminders but if you miss two payments and don't pay your bill by the date listed in that reminder, you'll be removed from the Medicare Prescription Payment Plan. You'll be 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 our Medicare Part D plan.

Failure to remain current on your payments could result in ineligibility for reenrollment in the program for the next year.

Call SimplicityRx at 1-833-696-2087 (TTY: 711), 7 a.m. - 12 a.m. CT (7 days a week from Oct. 15 - Dec. 7), otherwise, 7 a.m. - 10 p.m. CT (Monday - Friday), for questions about your bill and to understand your options for payment.

If I sign up, when can I expect the payment plan to start?

First you need to be enrolled with one of our Part D plans. If you sign up before January 2025, it could take 10 days to process your election form. If you sign up after January 2025, it’ll only take 24 hours — that way you won’t have to wait to get your Part D drugs.

Once we receive your election request, you'll be placed into the program, and you'll get a letter confirming your participation. If you do not receive a confirmation that you are enrolled, there may be missing information to complete your election into the program. Call SimplicityRx at 1-833-696-2087 (TTY: 711), 7 a.m. - 12 a.m. CT (7 days a week from Oct. 15 - Dec. 7), otherwise, 7 a.m. - 10 p.m. CT (Monday - Friday) to ask about your election into the program.

Can I remove myself from the Medicare Prescription Payment Plan?

You can remove yourself at any time from the program by calling SimplicityRx at 1-833-696-2087 (TTY: 711), 7 a.m. - 12 a.m. CT (7 days a week from Oct. 15 - Dec. 7), otherwise, 7 a.m. - 10 p.m. CT (Monday - Friday). You can also do it by signing in to your member account. Changes will show in your account within 24 hours.

You'll still need to pay any outstanding balances and will receive a monthly invoice until they are completely paid. Once you opt-out, no further out-of-pocket cost will be applied to your Medicare Prescription Payment Plan account, However, by opting out, you will be responsible for paying for your out-of-pocket costs to the pharmacy.

If I need my prescription right away, can I pay for it at the pharmacy and ask for it to be added into the Medicare Prescription Payment Plan later?

Yes. Any pharmacy paid claim that you filled up to three days prior to electing into the Medicare Prescription Payment Plan can be placed into your new account. Just call SimplicityRx and they'll add your pharmacy paid claims to your monthly payment amount and send you a credit in 45 days for drugs paid at the pharmacy.

What do I do if I need help paying for my drugs? 

The Low-Income Subsidy (LIS) program, also known as Extra Help, is a federal assistance program that helps Medicare beneficiaries with limited income and resources pay for prescription drugs under Medicare Part D. It provides significant financial relief for those who qualify by covering monthly premiums, annual deductibles, and copayments associated with prescription medications.

With recent expansions, more people may qualify for the LIS program due to updated income and resource limits. The expansion aims to provide broader access to financial help for prescription drugs, thereby reducing out-of-pocket costs for those with low incomes. This change may benefit individuals who previously did not qualify.

 Key changes for the recent LIS/Extra expansion

• Increased income limits: The expansion raises the income threshold for full Extra Help eligibility from 135% of the Federal Poverty Level (FPL) to 150% of FPL.
• Higher resource limits: The resource limits for LIS eligibility have also been increased, allowing beneficiaries with more savings and assets to qualify.
• Simplified automatic enrollment: More beneficiaries who are already enrolled in Medicare Savings Programs, Medicaid, or Supplemental Security Income (SSI) will be automatically enrolled in LIS without needing to apply.
• Elimination of partial LIS: Under the expanded eligibility, there's no longer a distinction between full and partial Extra Help. All individuals who qualify under the new income and resource limits will receive full Extra Help benefits.

 How to apply and enroll in LIS

If you believe you qualify for the LIS program, there are several ways to apply:

1. Apply online: The quickest way to apply is by visiting the Social Security Administration (SSA) website at www.ssa.gov and completing the LIS application form.
2. Apply by phone: You can call the SSA at 1-800-772-1213 (TTY: 1-800-325-0778) and request an application or apply over the phone.
3. Apply in person: Visit your local Social Security office to apply in person.
4. Through your state Medicaid office: Some states provide additional help with prescription drugs through Medicaid, so check with your state's Medicaid office.

 Why LIS may be more beneficial

For individuals who qualify, the LIS program is likely to be more advantageous than participation in the Medicare Prescription Payment Plan. Here’s why:

• Lower out-of-pocket costs: LIS provides much more comprehensive financial support.
• More predictability: There are no unexpected costs, as the subsidies cover most prescription-related expenses.
• No need to opt-in/opt-out annually: Once enrolled and qualified, you remain covered unless your income or resource situation changes drastically.

Given the recent expansions in LIS eligibility, it's worth considering this program if you are struggling with prescription drug costs.

Visit Medicare.gov/ExtraHelp to learn more.

If you think the Medicare Prescription Payment Plan is right for you, see how to enroll

There are two ways to sign up. You can enroll online or print out the application form (PDF) and mail it to SimplicityRx.

Download and print the application form (PDF)