Medicare Prescription Payment Plan

Consider Managing Your Monthly Drug Costs with the Medicare Prescription Payment Plan 

You might benefit from participating in the Medicare Prescription Payment Plan because you have high drug costs. 

What’s 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, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option for drugs covered by Part D. 

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 your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). All plans offer this payment option and participation is voluntary. It doesn’t cost anything 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. Select here to find out more information.

Will this payment option help me?

It depends on your situation. If you have high out-of-pocket drug costs, this payment option spreads out what you’ll pay each month across the calendar year (Jan – Dec), so you don’t have to pay out-of-pocket costs to the pharmacy. This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs. Visit Medicare.gov/basics/costs/help/drug-costs to learn about programs that can help lower your drug costs. 

How will my costs work with this payment option? 

The new prescription drug law caps your out-of-pocket costs at $2,000 in 2025 and eliminates the coverage gap (known as the “donut hole”). 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 your health or drug plan. 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. 

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 into your monthly payment, there are fewer months left in the year to spread out your remaining payments. Click here for examples of how monthly payments may mork.

How do I know if this payment option might not be right for me?

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) or a charity 
Who can help me decide if I should sign up for this payment option? 
  • Your health or drug plan: To get more information call BlueCross at 1-833-730-1719 (TTY users should call 711).
  • Medicare: Visit Medicare.gov/prescription-payment-plan or call 1-800-MEDICARE (1-800- 633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.
  • State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling. 
How do I sign up for this payment option? 

Sign up three ways:

  1. Call BlueCross at 1-833-730-1719
  2. Sign up online using My Health Toolkit 
  3. Download a hard copy and mail to:                                                                                 BlueCross Medicare Advantage
    Attn: Medicare Prescription Payment Plan
    P.O. Box 100191
    Columbia, SC 29202-3191

Terms and Conditions apply.

 

Need this information in another format or language? 

To get this material in other formats like large print, braille, or another language, contact BlueCross Medicare advantage or call 1-800-MEDICARE (1-800-633-4227).

Disclaimer

Last Updated: October 1, 2024

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BlueCross BlueShield of South Carolina is a Medicare Advantage PPO plan with a Medicare contract. BlueCross Rx Value is a stand-alone prescription drug plan with a Medicare contract. Enrollment in BlueCross Total, BlueCross Total Value, BlueCross Blue Basic, or BlueCross Rx Value depends on contract renewal. 

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. 

Out-of-network/non-contracted providers are under no obligation to treat BlueCross BlueShield of South Carolina Medicare members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call Customer Service or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 

BlueCross BlueShield of South Carolina does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation or health status in our health plans, when we enroll members or provide benefits. Free language interpretation services are available for those who cannot read or speak English.