Medicare Prescription Payment Plan

The Medicare Prescription Payment Plan is a payment option that works with your current drug coverage to help you manage your out-of-pocket costs for drugs covered by your plan by spreading them across the calendar year (January–December). 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, and participation is voluntary.

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). There’s no cost to participate in 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.

Even though you won’t pay for your drugs at the pharmacy, you’re still responsible for the costs. If you want to know what your drug will cost before you take it home, call your plan, or ask the pharmacist.

This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. Learn about other programs that might save you money, if you qualify.

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. All plans use the same formula to calculate your monthly payments. Review examples of how this payment option works in different situations.

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 costs get added to your monthly payment, there are fewer months left in the year to spread out your remaining payments.

In a single calendar year (January – December), you’ll never pay more than:

• The total amount you would have paid out of pocket to the pharmacy if you weren’t participating in this payment option.
• The out-of-pocket maximum for prescription drugs that are covered by your plan ($2,100 in 2026).

The prescription drug law caps your out-of-pocket drug costs for covered drugs at $2,100 in 2026. This is true for everyone with Medicare drug coverage, even if you don’t participate in the Medicare Prescription Payment Plan.

It depends on your situation. Remember, this payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.

You’re most likely to benefit from participating in the Medicare Prescription Payment Plan if you have high drug costs earlier in the calendar year. Although you can start participating in this payment option at any time in the year, starting earlier in the year (like before September), gives you more months to spread out your drug costs. Answer a few questions to find out if this payment option is likely to help you.

If there’s a drug that you’d like to take but it’s too expensive, and you think this payment option might spread out the cost enough to work for you, contact Member Services to confirm the drug is covered and get more help.

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 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.

Learn about programs that can help lower your costs.

There are several ways that you can opt in to participate in this payment option:

• Complete the Medicare Prescription Payment Plan Participation Request Form and mail it to:

  Central Health Medicare Plan

  Attn: Membership Accounting Department

  P.O. Box 22800

  Long Beach, CA 90801-9945

  Medicare Prescription Payment Plan Participation Request Form:

  English | Spanish | Chinese

• Fill out and submit the form directly through MyCHPPortal:
  • Log into the portal
  • Go to “My Plan Resources”
  • Click the “Helpful Links” tab
  • Go to “Medicare Prescription Payment Plan”
  • Fill out the form and submit
• Call Member Services at (866) 314-2427 (TTY: 711) and a representative can help you complete the form over the phone. We are available October 1 – March 31, 8 a.m. to 8 p.m. local time, 7 days a week. From April 1 – September 30, Monday – Friday, 8 a.m. to 8 p.m. local time.

If you are new to the plan, we will process your request within:

• 10 calendar days of receipt of your election form.
• If your enrollment in our plan will start sooner than 10 days from when we receive your election form, we will process your election before your enrollment in our plan starts so that you will be enrolled in the program on the same day that your plan starts.

If you are currently a member:

• We will process your request within 24 hours, but enrollment will be effective on the date we receive your completed request.
• If you paid any cost-share for an urgently needed prescription before we processed your election, we may make your election effective before we receive it. This can happen if you meet the following criteria:
• You believe that taking 24 hours to process your request may seriously jeopardize your life, health, or ability to regain maximum function.
• You request a retroactive election within 72 hours of the date and time you paid and received your urgently needed prescription.

After we approve your participation in the Medicare Prescription Payment Plan, you’ll get a letter from Central Health Medicare Plan with information about how to pay your bill.

You’ll get a reminder from your health or drug plan 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 your Medicare health or drug plan.

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 Member Services if you think there is a mistake with your Medicare Prescription Payment Plan bill. If you think there is a mistake, you have the right to follow the grievance process found in your Member Handbook or Evidence of Coverage.

You can leave the Medicare Prescription Payment Plan at any time by contacting Member Services. Leaving won’t affect your Medicare drug coverage and other Medicare benefits. Keep in mind:

• If you still owe a balance, you’re required to pay the amount you owe, even though you’re no longer participating in this payment option.
• You can choose to pay your balance all at once or be billed monthly.
• You’ll pay the pharmacy directly for new out-of-pocket drug costs after you leave the Medicare Prescription Payment Plan.

If you leave your current plan, or change to a new Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage), your participation in the Medicare Prescription Payment Plan will end.

Contact your new plan if you’d like to participate in the Medicare Prescription Payment Plan again.

You can visit Medicare.gov/prescription-payment-plan to see if this payment option might be a good fit for you. You can also call Member Services at (866) 314-2427. We are available October 1 – March 31, 8 a.m. to 8 p.m. local time, 7 days a week, or from April 1 – September 30, Monday – Friday, 8 a.m. to 8 p.m. local time. TTY users can call 711.