Medicare Prescription Payment Plan

You’re most likely to benefit from this payment plan if you have high drug costs early in the calendar year. If you join the plan later in the year, you’ll have fewer months to spread out your drug costs, resulting in higher monthly payments.

The payment plan may not be the best choice for you if:

• You have low yearly drug costs
• Your drug costs are the same each month
• 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 or other health coverage.

If you have limited income and resources, you may be eligible for Medicare’s Extra Help program, also called Low Income Subsidy (LIS). The Extra Help program for those who qualify is more advantageous than participation in the Medicare Prescription Payment Plan.

Extra Help is a Medicare program that helps pay your Medicare Part D prescription drug costs including premiums, deductibles and other costs. In 2024, the Extra Help program expanded to cover more drug costs for people with limited resources who earn less than 150% of the federal poverty level. In 2026, people who qualify for Extra Help generally will pay no more than $4.90 for each generic drug and $12.15 for each brand-name drug.

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.

Starting early in the calendar year gives you more months to spread out your drug costs. Note that while this payment plan helps manage your monthly expenses, it does not lower your total drug costs for the year. However, you’ll never pay more than:

• The total you would have paid to the pharmacy if you weren't participating in this payment plan
• The total annual out-of-pocket maximum for Part D drugs of $2,100 in 2026.

Your monthly bill is based on what you would have paid the pharmacy for any prescriptions you get, plus your previous month’s balance, if any, divided by the number of months left in the year. Your payment may increase each month as you fill new or recurring prescriptions.

If you are more than 60 days behind on paying your Medicare Prescription Payment Plan bills, you will be removed from the payment plan and will need to pay the pharmacy directly for your portion of new prescription drug costs. You may opt into the plan again only after you pay MyAdvocate Medicare Advantage the balance you owe. You will not be charged any interest or fees for the balance owed.

IMPORTANT: Always pay your Medicare Advantage plan premium first, if you have one, so you don’t lose your drug coverage. As long as you continue to pay the plan premium, you’ll still have drug coverage through your Medicare Advantage plan.

You can opt in to the payment plan through your MyAdvocate Medicare Advantage member portal beginning Jan. 1, 2026. To opt in prior to that, please download, fill out and mail the Medicare Prescription Payment Plan Participation Request Form to MyAdvocate Medicare Advantage or call Customer Service.

Once you have opted in, you can opt out anytime during the calendar year. If you opt out, however, you are required to pay MyAdvocate Medicare Advantage the entire balance remaining in your payment plan. You can choose to pay your balance all at once or be billed monthly.

You will need to opt in again each calendar year that you wish to participate in the Medicare Prescription Payment Plan. You can do this at the beginning of each year or anytime during that year, and we will immediately notify your pharmacy to send your prescription drug bills to MyAdvocate Medicare Advantage.

When you have certain urgent prescription fills for which you paid the associated cost sharing to the pharmacy before your Medicare Prescription Payment Plan election was received and processed, MyAdvocate Medicare Advantage will process a retroactive election if these two conditions are met:

• You believe that any delay in filling the prescriptions due to the 24-hour timeframe required to process your request to opt into the Medicare Prescription Payment Plan may seriously jeopardize your life, health or ability to regain maximum function.
• You request retroactive election into the Medicare Prescription Payment Plan within 72 hours of the date and time the urgent claims were adjudicated.

Once your Medicare Prescription Payment Plan election is active, MyAdvocate Medicare Advantage will reimburse you within 45 calendar days of the election date for all costs paid for the urgent prescriptions and any other covered Part D prescriptions filled between the date the urgent claim was adjudicated and the date your election is effectuated.

If MyAdvocate Medicare Advantage determines that you failed to request retroactive election within the required timeframe, we will promptly notify you of its determination and provide instructions on how you may file a grievance or complaint.

When you opt into the Medicare Prescription Payment Plan, MyAdvocate Medicare Advantage notifies your pharmacy to send your bills directly to us. You will not pay the pharmacy directly for your prescription drugs. We will send you monthly invoices payable to MyAdvocate Medicare Advantage that spread out your prescription costs throughout the year.

This status tells whether you have opted in, opted in pending approval, never opted in or opted out of the Medicare Prescription Payment Plan. If you would like to see your history of opting in and/or out of the payment plan, call Customer Service at 1-888-278-6485 (TTY: 711).

You can file a grievance or complaint if you feel MyAdvocate Medicare Advantage failed to properly process your request to elect the Medicare Prescription Payment Plan. Here are the options:

• Contact MyAdvocate Medicare Advantage Customer Service by phone at 1-888-278-6485 (TTY: 711). If there is anything else you need to do, Customer Service will let you know.

• If you do not wish to call (or you called and were not satisfied), put your grievance or complaint in writing and mail it to:

MyAdvocate Medicare Advantage Attn: Quality
P.O. Box 8000
Marshfield, WI 54449-8000

MyAdvocate Medicare Advantage will look into your grievance or complaint and give you our answer within the deadlines required by the Centers for Medicare and Medicaid Services. For detailed information about grievances and complaints, see your Evidence of Coverage and find the chapter titled “What to do if you have a problem or complaint (coverage decisions, appeals, complaints).”

Once you are enrolled, you will find Medicare Prescription Payment Plan billing and payment information when you log into the MyAdvocate Medicare Advantage member portal.