Your guide to the Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is an optional program that can help you manage your prescription payments. With this program:

• Costs for your covered Part D prescriptions are spread out over the plan year
• You pay $0 at the pharmacy when you fill new or existing covered Part D prescriptions
• You’ll receive a monthly bill from Humana with the amount you owe, your due date, and instructions on how to make a payment

Note: This program can only help you manage your expenses—it can’t save you money or lower your drug costs.

The Medicare Prescription Payment Plan may help you manage your Part D prescription drug costs. Here are some tips to help you decide:

• If during the prior plan year, you filled a single prescription costing more than $600.  
• If you have spent more than $2,000 on your covered Part D prescriptions
• If you sign up early in the new plan year (the more months you have in the program, the more your payments will be spread out)

This payment option might not be helpful if you:

• Have prescription costs that are the same month to month
• Have higher drug costs later in the year, as your balance would need to be paid off by year end
• Are eligible for a Dual Eligible Special Needs Plan  
• Qualify for cost savings programs :
  • Extra Help/Low-Income Subsidy (LIS)
  • Medicare Savings Program
  • State Pharmaceutical Assistance Program (SPAP)
  • Manufacturer’s Pharmaceutical Assistance Programs, sometimes called Patient Assistance Programs (PAPs)

For more information, visit Medicare.gov’s Prescription Payment Plan page opens in new window  or contact your local Social Security office. You can find your local Social Security office at ssa.gov/locator opens in new window  or by calling 800-772-1213. TTY users can call 800-325-0778, Monday – Friday, 8 a.m. – 7 p.m., local time.

Once you have enrolled in a plan that offers prescription drug coverage, you can opt in or out at any time at Humana.com/MPPP opens in new window . To opt in online, you’ll need to register or sign in to MyHumana. 

Here you’ll find:

• Program information
• Frequently Asked Questions
• Balance and transaction history
• and more!

To opt in through the mail, you can print, fill out and mail a Medicare Prescription Payment Plan Participation Request Form to the address on the form.

Medicare Prescription Payment Plan Participation Request Form—English pdf opens in new window

Medicare Prescription Payment Plan Participation Request Form—Spanish pdf opens in new window

Medicare Prescription Payment Plan Participation Request Form—Chinese pdf opens in new window

If you have questions about the Medicare Prescription Payment Plan, please contact Customer Service by dialing the number on the Back of your ID Card. You can call us seven days a week, from 8 a.m. to 8 p.m. Please note that our automated phone system may answer your call during weekends and holidays.

Voluntary Opt-out of the Medicare Prescription Payment Plan

When you opt out of The Medicare Prescription Payment Plan here’s what happens:

• Going forward, you’ll pay your pharmacy directly for all your covered Part D drug costs. (This also applies to mail-order and specialty pharmacies.)
• You will continue to receive monthly bills for the amount incurred while in the program until your balance is paid.
• You also have the option to pay the balance in full at any time.

If you choose to participate in the program in the future, you simply opt-in as you did before.

Do I need to sign up every year?

If you remain in the same Humana drug plan, your participation in the Medicare Prescription Payment Plan will continue into the next plan year unless you opt out. If you change Medicare plans, you will have to opt in again.

In certain situations, an “urgent election” may allow you to enroll in the Medicare Prescription Payment Plan after you’ve already received a prescription. If you believe a delay in filling your covered prescription may seriously jeopardize your life, health, or ability to regain maximum function, call Humana at 800-222-0018 (TTY: 711) to learn more about your options. 

In the Medicare Prescription Payment Plan (the program), you will get a monthly bill from Humana instead of paying for your covered Part D prescriptions at the pharmacy.  For your first month, based on your start date in the program, your monthly payment could be as high as your total covered Part D drug costs for that month.

Your monthly bill is based on what you owe for any prescriptions you get, plus any balance from the previous month, divided by the number of months left in the year. Your payment can change every month as you fill new prescriptions or refill existing ones.  These will be added to your balance, which may change from month to month.

You will never pay more in 1 year than the CMS Part D maximum out-of-pocket limit for the plan year you are enrolled in. This is true for everyone with Medicare drug coverage, even if they don’t join the Prescription Payment Plan program.

Finally, it doesn’t cost anything to participate in the program and you won’t pay any interest or fees on the amount you owe.

View monthly cost examples pdf opens in new window

View monthly cost examples – Spanish pdf opens in new window

Estimate your monthly payment with this calculator opens in new window  by entering your estimated Part D prescription costs.

Note: Your monthly payment calculation is done every month to capture both your balance and the remaining months left in the year.

If you don’t pay your monthly bill

If you don’t pay your past-due balance, here’s what you can expect:

• You will continue to receive bills until your past-due balance is paid.
• There is a 2-month grace period beginning the first day of the month following a missed payment notification. If a payment isn’t received by the end of the grace period, your participation in the program will be terminated and you won’t be eligible to rejoin until the balance is fully paid.

Note: This only applies to your participation in the Medicare Prescription Payment Plan. Your Medicare drug coverage and other Medicare benefits will not be affected, and you’ll continue to be enrolled in your plan for your drug coverage.

Here are some contacts that could help you decide if the program is right for you:

Medicare—Visit Medicare.gov opens in new window , or call 1-800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY users can call 877-486-2048.

State Health Insurance Program (SHIP)—Visit shiphelp.org opens in new window  to get the phone number for your local SHIP and get free, personalized health insurance counseling.

Humana—If you have questions about the Medicare Prescription Payment Plan, please contact Customer Service by dialing the number on the Back of your ID Card. You can call us seven days a week, from 8 a.m. to 8 p.m. However, please note that our automated phone system may answer your call during weekends and holidays.

If you disagree with our decision, you have the right to ask Humana for a review. Go to our file a complaint online page  to submit an appeal. You must submit your appeal within 60 days after the incident or event initiating the grievance.