Medicare Prescription Payment Plan
Covering the cost of prescription medications isn’t always easy, especially on a fixed budget. The Medicare Prescription Payment Plan can help you manage your prescription drug costs by spreading out the payments over the year. It’s voluntary, free to join and works with your Medicare Prescription Drug coverage.
How does the Medicare Prescription Payment Plan work?
New for 2025, the Medicare Prescription Payment Plan is a payment option created under the Inflation Reduction Act and applies to any plan with Medicare Prescription Drug coverage. If you expect to meet your out-of-pocket maximum early in the calendar year, or struggle with fluctuating monthly prescription costs, the Medicare Prescription Payment Plan may be a good fit for you.
Here’s how it works:
- Starting on January 1, 2025, Medicare Prescription Payment Plan participants will pay $0 to the pharmacy for covered Part D drugs. Instead, Blue Cross Blue Shield of Massachusetts will bill members monthly for costs incurred for prescription medications.
- Medicare's prescription payment plan calculates monthly payments based on the following factors:
- Previous balance: The previous month's balance is added to the total cost of prescriptions for the month
- Number of months left in the year: The total is then divided by the number of months remaining in the year
- Monthly payments may change each month, and can increase if new prescriptions are filled or existing ones are refilled. This is because there are fewer months left in the year to spread out the remaining payments
- The program does not reduce the out of pocket costs a member owes for their Part D prescriptions and is not appropriate for everyone.
See if the Medicare Prescription Payment Plan is right for you.
*Note: Starting Jan. 1, 2025, the “Coverage Gap" phase for Part D plans has been eliminated for all plans, whether you participate in the Medicare Prescription Payment Plan or not. Once a member hits the $2,000 annual out-of-pocket threshold, they automatically enter the “Catastrophic Phase" of their Part D benefit.
How do I opt in?
There are three ways to enroll in the Medicare Prescription Payment Plan:
Frequently Asked Questions
Applications received prior to the 2025 plan year will be processed within 10 calendar days of receiving them or before the plans begins, whichever comes first. Applications received during the 2025 plan year, will be processed within 24 hours to avoid any delays in medication access.
If you paid the associated out-of-pocket cost for certain urgent prescription fill(s) before your application was received and processed, the plan must process the reimbursement for all out-of-pocket costs paid by you within 45 calendar days of your election date.
Additional information can be found in the Medicare Prescription Payment Plan frequently asked question sheet created by the Centers for Medicare & Medicaid Services. You can also watch this helpful video for more details.
If you have concerns about any part of the program or your prescription drug coverage, you can file a complaint at any time. Visit our Appeals and Grievance process page to learn more.
