New Program Makes Installment Payments an Option for Medicare Part D Enrollees

Any individual with Part D coverage can enroll in the program, whether the coverage is standalone Part D coverage or part of a Medicare Advantage plan.

Pharmacies are required to notify Part D enrollees about the Medicare Payment Prescription Plan each time they have a single prescription that requires at least $600 in out-of-pocket payments. The pharmacy, however, won't have information about the program aside from a basic notification that the individual is "likely to benefit" from it. The enrollee receives that information from the Part D plan.

The plan itself may also send an election form when an individual is eligible to participate in the Medicare Payment Prescription Plan and likely to benefit, whether with the individual's 2025 plan card or separately. It's the individual's responsibility to participate in the program; there will be no automatic enrollment once the individual is eligible.

The Medicare Payment Prescription Plan is available only with respect to Medicare Part D-covered prescription drugs. Prescriptions provided by a doctor in connection with Part B coverage are not covered, nor is durable medical equipment.

Enrollees can opt in before the plan year or at any time during the plan year. Part D sponsors will be required to process requests to participate in the Medicare Payment Prescription Plan within 24 hours of the election if the request is made during the plan year. If the request is made before the plan year, they have 10 days to process the request.

The amount of the individual's bill will be calculated by the Part D plan and can vary from month to month if the individual adds a new prescription. If the individual misses a payment, the Part D plan will issue notifications about the missed payment and must offer a grace period to pay. However, the enrollee's participation can be terminated, and  full payment required, if the enrollee still does not pay the amount due.

Enrollees also have the right to opt out of the program once they have elected to participate. For example, if keeping track of another monthly bill becomes more of a hassle than a benefit, the individual can always decide to opt out and pay the remaining balance.