Medicare Prescription Payment Plan (M3P) FAQs
Discover the latest information on Medicare’s Prescription Payment Plan, offering a solution for managing your prescription costs!
Starting in 2025, the Inflation Reduction Act requires all Medicare prescription drug plans (including standalone Medicare Part D plans and Medicare Advantage plans with prescription drug coverage) to offer enrollees capped monthly payments for out-of-pocket prescription drug costs. This change aims to enhance affordability for beneficiaries.
What is the Medicare Prescription Payment Plan?
The Medicare Prescription Payment Plan is a new option available starting in 2025 that allows you to spread out your out-of-pocket Medicare Part D drug costs across the calendar year. This option works with your existing drug coverage, whether you have a Medicare drug plan or a Medicare Advantage Plan with drug coverage. Participation in this plan is voluntary and available through all medicare plans.
How does it work?
Instead of paying for your prescriptions directly at the pharmacy, you’ll receive a monthly bill from your health or drug plan. This bill will include the costs of any prescriptions you’ve filled, divided by the remaining months in the year. While this plan can help manage your monthly expenses, it does not reduce your overall drug costs.
How Are Costs Calculted?
Costs will be calculated based specifically on your personal prescription drug costs. Below is an example of how costs may be calculated.
Scenario:
- Your medications cost $500 out-of-pocket each month
- You join the payment plan in January 2025
- The annual out-of-pocket maximum is $2,000
Here’s how your payments work:
January (First Month):
- Maximum monthly payment = $2,000 ÷ 12 = $166.67
- Actual drug cost = $500
- You pay: $166.67 (the lower amount)
- Remaining balance: $333.33 carries over
February:
- Add new month’s costs: $333.33 + $500 = $833.33
- Divide by remaining months (11)
- You pay: $75.76
March:
- Add new month’s costs: $757.57 + $500 = $1,257.57
- Divide by remaining months (10)
- You pay: $125.76
April:
- Add new month’s costs: $1,131.81 + $500 = $1,631.81
- Divide by remaining months (9)
- You pay: $181.31
Key Points:
- Your monthly payment varies but helps spread out the high costs
- You’ll never pay more than $2,000 total for the year
- After reaching the $2,000 maximum, you won’t have additional out-of-pocket costs
- You still need to pay your regular plan premium separately
This plan essentially helps you avoid paying $500 each month by spreading the costs more evenly throughout the year.
What should you consider before participating?
Payment Structure: The Medicare Prescription Payment Plan is free to join with no fees and no interest. Your monthly payment is based on the cost of your prescriptions and the number of months left in the year. Payments may fluctuate, especially if you fill new prescriptions.
Out-of-Pocket Cap: Regardless of whether you participate in this plan, your total out-of-pocket drug costs for the year are capped at $2,000 starting in 2025.
Suitability: This option is most beneficial if you have high costs early in the year, as it allows more time to spread out the payments. However, it might not be ideal if your drug costs are low, consistent, or if you qualify for other assistance progams. This payment option may 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.
How do you sign up?
There are a few ways to enroll in the Medicare Prescription Payment Plan (M3P):
- If you are already an eternalHealth member, simply log into your Optum Rx Portal and complete the election form.
- If you haven’t joined eternalHealth yet but plan on enrolling, you can easily fill out the election form here in advance.
- Once enrolled as an eternalHealth member we will send you a paper election form along with your Member ID Card.
- Alternatively, you can access and print the election form here, and send it back to the address provided on the form.
Using The Medicare Prescription Payment Plan
This program is meant to help you spread your costs throughout the year, and make the bills easier to pay over time instead of all at once. It is very important to pay your bills every time, on time. That way, you can continue to use the program and benefit from spreading the cost out. We offer several ways for you to pay, including:
- Online at optumrx.com, by credit/debit card or bank account.
- Through the mail, by check. To make sure your payment is credited correctly, please include a copy of this letter or your billing statement with your check. Write your Member ID on the check and send to:
Optum Rx MPPP
PO Box 67
Minneapolis, MN 55480-0067
- By phone. Customer service can assist with payments over the phone.
If you have questions about your payment, call us at 1-844-368-8729, 5:00 a.m CST – 10:00 p.m CST, 7 days a week. TTY users can call 711.
What happens if I don’t pay my bill?
You’ll get a reminder from us in the mail if you miss a payment. If you don’t pay your bill by the date listed in that reminder, you’ll be removed from the Medicare Prescription Payment Plan. You’re 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 eternalHealth.
Always pay your health or drug plan monthly premium first (if you have one), so you don’t lose your drug coverage. If you’re concerned about paying both your monthly plan premium and Medicare Prescription Payment Plan bills, learn about programs that can help lower your costs.
You can call us at 1-844-368-8729 if you think we made a mistake about your Medicare Prescription Payment Plan bill. If you think we made a mistake, you have the right to file a grievance with us when you call.
What if you change your mind?
You can leave the Medicare Prescription Drug Plan (M3P) at any time without affecting your Medicare drug coverage. However, any outstanding balance must still be paid.
Want to learn more?
If you’re unsure whether this payment option is right for you, consider talking to your health or drug plan, contacting Medicare directly, or reaching out to your local State Health Insurance Assistance Program (SHIP) for personalized advice.
Are you ready to select a Medicare Prescription Payment Plan?
Want to sign up for the Medicare Prescription Payment Plan (M3P)?
Choose an option below to sign up:
- If you are already an eternalHealth member, simply log into your Optum Rx Portal and complete the election form.
- If you haven’t joined eternalHealth yet but plan on enrolling, you can easily fill out the election form here in advance.
- Alternatively, you can access and print the election form here, and send it back to the address provided on the form.
- Click here for more education on the Medicare Prescription Payment Plan (M3P)
If you still have questions about the Medicare Prescription
Payment Plan, call us at 1-844-368-8729, 5:00 a.m CST – 10:00 p.m
CST, 7 days a week. TTY users can call 711.