Medicare Prescription Payment Program.
The Medicare Prescription Payment Program is a 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). 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. All plans offer this payment option and participation is voluntary.
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 us or ask the pharmacist.
The prescription drug law caps your out-of-pocket drug costs at $2,400 in 2027. This is true for everyone with Medicare drug coverage, even if you don’t participate in the Medicare Prescription Payment Plan. If you would like to sign up, you may contact us, and we will process your election enrollment within 24 hours of receipt.
If you select this payment option, each month you’ll continue to pay your monthly premium (if you have one), and you’ll get a bill each month from us to pay for your prescription drugs (instead of paying the pharmacy).
There’s no cost to participate in the Medicare Prescription Payment Program, and you won’t pay any interest or fees on the amount you owe, even if your payment is late.
It depends on your situation. 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.
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 become eligible for Extra Help from Medicare.
- You become 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.
Answer a few questions to find out if you're likely to benefit from this payment option and learn about ways to help with Medicare costs.
View examples of how Medicare Prescription Payment Plan monthly costs are calculated.
To participate in this prescription payment plan, you may opt in by:
- Enrolling on the pharmacy portal
- Downloading and mailing the Medicare Prescription Payment Plan Participation Request Form
- Calling the Pharmacy Help Desk at 833-840-2573 (TTY: 711). Follow the voice prompt for Medicare Prescription Payment Plan.
FAQs
Frequently asked questions.
How do I leave the Medicare Prescription Payment Plan?
You can leave the Medicare Prescription Payment Plan at any time and leaving does not affect your Medicare drug coverage or other Medicare benefits. If you still owe a balance, you are required to pay the amount you owe, even though you are no longer participating in the payment plan. You can pay this balance all at once or be billed monthly. You’ll pay the pharmacy directly for any new out-of-pocket prescription costs after you leave the Medicare Prescription Payment Program.
What if I miss a payment?
You will receive a reminder if you miss a payment. You are required to pay the amount you owe, but even if your payment is late, you do not pay interest or fees. It’s important to pay your bill by the date listed on the reminder, or you may be removed from the Medicare Prescription Payment Program. You will still be enrolled in your Medicare Advantage Plan, even if you are removed from the Medicare Prescription Payment Plan. Always pay your health plan monthly premium first (if you have one), so you don’t lose your health plan coverage.
How do a file a complaint or grievance about the Medicare Prescription Payment Plan?
If you think we made a mistake, you have the right to file a complaint (sometimes called a “grievance”). For more information about the grievance process, please visit our Contact Us page or your Evidence of Coverage (EOC) document for how to file a complaint.
Low Income Subsidy Program.
The Low Income Subsidy (LIS), also called the “Extra Help” program, is a federal program that assists people with Medicare who have limited income and resources. It helps pay for Medicare Part D prescription drug costs.
If you qualify, you’ll get written notice (an “LIS rider”) showing how much help you’ll get next year towards your Part D drug plan premium, deductible and copayments. You will receive the same coverage as outlined in your Evidence of Coverage as someone who is not getting extra help. You must also continue to pay your Medicare Part B premium.
If you get Extra Help from Medicare to help pay for your Medicare prescription drug costs, your monthly plan premium may be lower than it would be if you did not receive Extra Help from Medicare. For members who receive Extra Help, here are the monthly premiums for our plans:
- St. Luke's Advantage Rx 01 (HMO): $31.49 per month
- St. Luke's Advantage Rx 02 (HMO): $96.49 per month
- St. Luke's Advantage Rx 03 (HMO): $61.49 per month
These premiums do not include any Medicare Part B premium you may have to pay. The premium includes coverage for both medical services and prescription drug coverage.
Medicare and/or Social Security will periodically review your eligibility to make sure that you still qualify. Your eligibility for extra help might change if there is a change in your income or resources, if you get married or become single, or you lose Medicaid. You will be notified in writing if your status changes.
If you aren't getting Extra Help, you can see if you qualify by calling:
- 800-MEDICARE (800-633-4227), 24 hours a day, 7 days a week. TTY users: call 877-486-2048.
- The Idaho Medicaid department at 877-456-1233 (TTY: 711) between 8 a.m. to 5 p.m. Monday through Friday except state and federal holidays.
- The Social Security Administration at 800-772-1213 between 8 a.m. to 7 p.m. Monday through Friday. TTY users: call 800-325-0778, Monday through Friday, 8 a.m. to 7 p.m.
If you have questions, please call St. Luke's Health Plan customer service.