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What Is the Medicare Prescription Payment Plan?
The Medicare Prescription Payment Plan is a new payment option that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January–December).
Starting in 2025, you can use this payment option for drugs covered by Elevate Medicare Advantage. Participation is voluntary.
Here's How the Medicare Prescription Payment Plan Works
If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from Elevate Medicare Advantage to pay for your prescription drugs (instead of paying at the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan, and you won’t pay any interest or fees on the amount you owe, even if your payment is late.
It depends on your situation. If you have high out-of-pocket drug costs early in the calendar year, this payment option spreads out what you’ll pay each month, so you don’t have to pay out-of-pocket costs to the pharmacy. This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. There are additional programs that may help lower your drug costs. Visit Medicare.gov to learn more.
This program is designed to help members with higher out-of-pocket medication costs, particularly those who:
- Incur $2,000 or more in prescription drug costs in a year
- Spend $600 or more on a single medication
If we identify you may be likely to benefit, we will send you a Medicare Prescription Payment Plan Likely to Benefit Notice.
This payment option might 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
It is free to join, and there are no fees or interest charged under the program. The prescription drug law caps your out-of-pocket costs at $2,000 in 2025. This means you’ll never pay more than $2,000 in out-of-pocket drug costs in 2025. This is true for everyone with Medicare drug coverage, even if you don’t join the Medicare Prescription Payment Plan.
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 Elevate Medicare Advantage. 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.
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 your plan or ask the pharmacist.
Note: 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 drug costs get added to your monthly payment, there are fewer months left in the year to spread out your remaining payments.
Cost for the First Month:
Annual OOP Threshold (–) Incurred Costs of the Enrollee (÷) Months Remaining in the Plan Year
Cost for the Second Month
Remaining OOP Costs Not Yet Billed to Enrollee (+) Additional OOP Costs Incurred by the Enrollee (÷) Months Remaining in Plan Year
See these examples on how to calculate the first month or subsequent monthly payments.
When you get your monthly payment for the Medicare Prescription Payment Plan that is due, you must pay it to stay enrolled in the program. The payments are for participation in the Program and does not affect your Elevate Medicare Advantage Medicare enrollments or benefits.
If you don’t pay your bill, you will be removed from the Medicare Prescription Payment Plan through Elevate Medicare Advantage, and you’ll pay the pharmacy directly for new out-of-pocket drug costs. Enrolling into the program requires you to pay the amount you owe, but you won’t pay any interest or fees, even if your payment is late.
Pay My Premium
You may choose from three ways to enroll in the Medicare Prescription Payment Plan
- Enroll online
Online Enrollment Form - Call our Health Plan Services
303-602-2111 or toll-free 1-877-956-2111.
TTY users should call 711.
Our hours of operation are 8 a.m. – 8 p.m., seven days a week. - Print and mail the form to:
Elevate Medicare Advantage
777 Bannock St., MC 6000
Denver, CO 80204
If you opt in before the plan year begins, we will process your request within 10 calendar days and send you a notification. If you opt in during the plan year, we will process your request within 24 hours.
Urgent requests
If you have urgent prescription fill(s) for which you had paid cost-sharing before your election into the program was received and processed, we will process a retroactive election. A retroactive election will be processed if the following conditions are met:
- You reasonably believe that any delay in filling the prescription(s) due to the 24-hour timeframe required to process your request to opt in may seriously jeopardize your life, health or ability to regain maximum function; and
- You request retroactive election within 72 hours of the date and time the urgent claim(s) were adjudicated.
Once we effectuate your enrollment, we will process the reimbursement for all cost sharing you paid for the urgent prescription and any covered prescriptions filled between the date of fill and the date that your election was effectuated within 45 days of the effectuation date.
If you do not meet the criteria for an urgent request, we will notify you promptly of our determination and provide instructions on how you may file a grievance (complaint).
Once your request has been accepted, we will send you a notification of acceptance and mail you a new Member ID card which you should begin using to tell the pharmacy you pay $0 at the point of sale.
You should make sure you pay your monthly bill we send you to remain enrolled in the program. If you do not make the required payments, we will disenroll you.
If you would like to opt out of the program, you can:
Call
303-602-2111 or toll-free 1-877-956-2111. TTY users should call 711. Our hours of operation are 8 a.m. – 8 p.m., seven days a week.
Mail
Elevate Medicare Advantage
777 Bannock St., MC 6000
Denver, CO 80204
If you ask to stop participating, or you changed your Medicare plan, you’re still required to pay the amount you owe, but you won’t pay 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 have questions about paying your balance, you can call our Health Plan Services at 303-602-2111 or toll-free at 1-877-956-2111. TTY users should call 711. Our hours of operation are 8 a.m. – 8 p.m., seven days a week.
Once you’ve been disenrolled from the Program, you’ll pay the pharmacy directly for your new out-of-pocket drug costs.
If you've joined a new plan and you’d like to participate in the Medicare Prescription Payment Plan again, contact your new plan.
If you ask to stop participating, you should use your original Member ID card again at the pharmacy.
Call us at 303-602-2261.
Our hours of operation are Monday – Friday, 8 a.m. – 5 p.m. You have the right to ask us to reconsider our decision through the grievance (complaint) process, which is outlined in your Evidence of Coverage (EOC).
If you need help to decide if you should enroll or if you have questions about the program:
- Call our Health Plan Services at 303-602-2111 or toll-free 1-877-956-2111. TTY users should call 711. Our hours of operation are 8 a.m. – 8 p.m., seven days a week.
- Visit Medicare.gov to learn more about this payment option and if it might be a good fit for you.
- Refer to the Medicare.gov fact sheet titled What's the Medicare Prescription Payment Plan?
- Visit the State Health Insurance Assistance Program website to get the phone number for your local SHIP and get free, personalized health insurance counseling.
Additional Programs That May Help With Costs
There are other programs that may help you lower your costs. If you have limited income and resources, find out if you’re eligible for one of these programs.
Extra Help is a Medicare program that helps you pay your Medicare drug costs. Visit the Social Security website to find out if you qualify and apply. You can also visit with your State Medical Assistance (Medicaid) office.
| Income and Resource Limits in 2024 | ||
| Your Situation | Income Limit | Resource Limit |
| Individual | $22,590 | $17,220 |
| Married Couple | $30,660 | $34,360 |
Low Income Subsidy (Extra Help) enrollment, for those who qualify, is likely to be more advantageous than participation in the Medicare Prescription Payment Plan.
Visit Medicare.gov to learn more.
State-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurances. Visit Medicare.gov learn more.
If you have questions about these programs or need help applying, you can contact our Sales Agents at 303-602-2999.
To Apply
Complete the Medicare Prescription Payment Plan Participation Request form online or by mail.
Visit Medicare.gov to learn more.