Medicare Prescription Payment Plan FAQs
Discover the latest information on Medicare’s Prescription Payment Plan, offering a solution for managing your prescription costs!
Medicare Prescription Payment Plan
Frequently asked questions for 2027
The Medicare Prescription Payment Plan is a free payment option that works with your eternalHealth drug coverage. Instead of paying the pharmacy when you fill a prescription, you get a monthly bill that spreads your Part D drug costs across the calendar year (January–December). It can make large drug costs easier to manage, but it does not lower what you pay overall.
- $0No cost to join, and no interest or fees, even on late payments
- $2,400Most you'll pay for covered Part D drugs in 2027
- Any timeJoin or leave during the year. It's voluntary.
- MonthlyOne bill for your drug costs, separate from your plan premium
How it works
eternalHealth does not provide pharmacy benefits for the Valor Give Back plan, so please do not sign up for the Medicare Prescription Payment Plan through eternalHealth. Contact your pharmacy benefits provider instead.
When you fill a prescription for a drug covered by Part D, you won't pay the pharmacy, including mail order and specialty pharmacies. Instead, each month you'll get a bill for your prescription costs.
You're still responsible for these costs. If you want to know what a drug will cost before you take it home, call us or ask your pharmacist.
Your monthly bill can change from month to month, so you may not know the exact amount ahead of time. In a single calendar year, you'll never pay more than:
- The total you would have paid the pharmacy if you weren't in the payment plan.
- The out-of-pocket maximum for covered Part D drugs, which is $2,400 in 2027.
The $2,400 cap applies to everyone with Medicare drug coverage, whether or not you join the payment plan. You'll keep paying your monthly plan premium (if you have one) separately.
Will this help me?
It depends on your situation. The payment plan can help you manage monthly expenses, but it doesn't save you money or lower your drug costs.
Most likely to help if
- You have high drug costs early in the year.
- You sign up earlier in the year (before September), so costs are spread over more months.
- A drug you need is too expensive to pay for all at once.
May not be the best choice if
- Your yearly drug costs are low.
- Your drug costs are the same each month.
- You're signing up late in the year (after September).
- You don't want to change how you pay for your drugs.
- You get, or qualify for, Extra Help or a Medicare Savings Program.
- You get help paying for drugs from a State Pharmaceutical Assistance Program, a coupon program, or other coverage.
Not sure? Call eternalHealth Member Services, or answer a few questions on Medicare.gov here. If you need to pick up a prescription urgently, call us to talk through your options.
How to sign up
You can sign up any time during the calendar year. Choose whichever way is easiest for you:
- Online, if you're already a memberLog in to the Optum Rx portal and complete the election form.
- Online, before your coverage startsIf you're not yet a member, you can complete the election form online in advance.
- By mailNew members get a paper election form with their member ID card. You can also print the form below and mail it to the address on the form.
What happens after I sign up?
We'll review your request and send you a letter confirming you're in the payment plan, with information on how to pay your bill. Then:
- When you fill a Part D-covered prescription, we'll let the pharmacy know you're in the payment plan, so you won't pay at the pharmacy.
- Each month, you'll get a bill showing what you owe, when it's due, and how to pay. Your plan premium (if you have one) is billed separately.
Your participation renews automatically each year unless you change plans or contact us to opt out.
How your bill is calculated
Every Medicare plan uses the same formula. Each month, new prescription costs are added to what you still owe, then divided by the months left in the year:
Your first month works a little differently. We take $2,400 minus any drug costs you've already paid this year, and divide it by the months left. That's your "maximum possible payment." You'll pay whichever is lower: that amount, or your actual drug costs for the month.
Because new costs get spread over fewer remaining months, your bill can go up when you fill a new prescription or a refill later in the year.
Two examples from Medicare
| Month | Without the plan | With the plan |
|---|---|---|
| January | $600 | $200.00 |
| February | $600 | $90.91 |
| March | $600 | $150.91 |
| April | $600 | $217.58 |
| May–Dec | $0 each | $217.57 each |
| Total | $2,400 | $2,400 |
In April you reach the $2,400 cap, so there are no new costs after that. Instead of four $600 payments, you pay about $200 a month all year.
| Month | Without the plan | With the plan |
|---|---|---|
| January | $80 | $80.00 |
| March | $80 | $15.27 |
| June | $80 | $45.59 |
| September | $80 | $94.93 |
| December | $80 | $241.59 |
| Total | $960 | $960 |
Selected months shown. Bills start low but rise steeply from September, ending at $241.59 in December. With steady costs, the plan may not help.
In both examples you pay the same total for the year either way. The payment plan only changes when you pay. You can see more examples in Medicare's Medicare Prescription Payment Plan information.
Paying your bill
Optum Rx manages billing for the eternalHealth Medicare Prescription Payment Plan. You can pay in any of these ways:
Pay at optumrx.com with a credit or debit card, or from your bank account.
Send a check with your member ID and a copy of your statement to:
Optum Rx Medicare Prescription Payment PlanPO Box 67
Minneapolis, MN 55480-0067
Always pay your monthly plan premium first (if you have one), so you don't lose your drug coverage. If paying both is a concern, see programs that can lower your costs.
If you think there's a mistake on your bill, call us. You have the right to file a grievance using the process in your Evidence of Coverage.
If you miss a payment
We'll send you a reminder. If you don't pay by the date in that reminder, you'll be removed from the payment plan, but you'll stay enrolled in your eternalHealth plan and keep your drug coverage.
You'll still need to pay what you owe. You won't be charged any interest or late fees, and you can pay the balance all at once or be billed monthly.
Leaving or changing plans
How do I leave the payment plan?
You can leave at any time by contacting us. Leaving won't affect your Medicare drug coverage or other benefits. Keep in mind:
- You'll still need to pay any balance you owe. You can pay it all at once or be billed monthly.
- After you leave, you'll pay the pharmacy directly for new prescriptions.
What if I change health or drug plans?
If you leave eternalHealth or switch to another Medicare drug plan or Medicare Advantage plan with drug coverage, your payment plan participation ends. Contact your new plan if you'd like to join its payment plan.
Programs that can lower your costs
The payment plan doesn't reduce what you pay. If you have limited income and resources, you may qualify for one of these programs. Many people qualify and don't realize it.
- Extra Help: a Medicare program that helps pay Part D drug costs. Apply at SSA.gov/medicare/part-d-extra-help or through your state Medicaid office. Learn more at Medicare.gov/ExtraHelp.
- Medicare Savings Programs: state programs that may help pay Medicare premiums, deductibles, copayments and coinsurance. Learn more at Medicare.gov/medicare-savings-programs.
- State Pharmaceutical Assistance Programs (SPAPs): may help with drug plan premiums and cost sharing. Learn more at go.Medicare.gov/spap.
- Manufacturer Patient Assistance Programs (PAPs): drug manufacturer programs that help lower drug costs. Learn more at go.Medicare.gov/pap.
See all options at Medicare.gov/basics/costs/help, or contact your local Social Security office (SSA.gov/locator).
Processing timeframes
Here's how quickly we process election requests, depending on when we receive them.
Before the plan year starts
| Request | What we do | Timeframe |
|---|---|---|
| Missing a signature or other required information | Contact you by mail, phone or email to complete the request. We must receive the missing information within 21 calendar days of your request. | 10 calendar days |
| Complete and accurate request | Process the request | 10 calendar days |
| Request made during plan enrollment | Confirm we received it, process it, and mail you an approval with your effective date, a request for more information, or a denial | 10 calendar days, or the number of days before enrollment starts, whichever is shorter |
During the plan year
| Request | What we do | Timeframe |
|---|---|---|
| Election request | Process the request | 24 hours |
| Retroactive Extra Help (LIS) eligibility with an election request | Process the requestProcess retroactive claims and make any refunds or recoveries | 24 hours45 days |
| We don't process your election within 24 hours | Make your election effective back to the original dateReimburse any out-of-pocket costs and add them to your monthly bill | 24 hours after receiving the information45 days |
| Urgent request: you paid for urgent prescriptions before we received your election | Process your election and reimburse those costs if both of these are true:
| Election: 24 hoursRefund: 45 days |
Get help
- October 1st – March 31st
- 8am – 8pm local time | 7 Days a Week
- April 1st – September 30th
- 8am – 8pm local time | Monday – Friday
Your State Health Insurance Assistance Program (SHIP) also offers free, unbiased Medicare counseling.
