Home Members Medicare Advantage Members Medicare Prescription Payment Plan
Consider managing your monthly drug costs with the Medicare Prescription Payment Plan.
The Medicare Prescription Payment Plan is a new payment option in the prescription drug law 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). All plans offer this payment option and participation is voluntary. Please note, that while this payment option may help you plan for and manage your expenses, it doesn’t lower your drug costs.
The Medicare Prescription Payment Plan is a new payment option that works with you to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January through December). 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 Samaritan Advantage Health Plans via OptumRx to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost 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.
It depends on your situation. If you have high out-of-pocket drug costs earlier in the calendar year, this payment option spreads out what you’ll pay each month across the calendar year (January through December), so you don’t have to pay out-of-pocket costs to the pharmacy. This payment option might help you manage your monthly 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.
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 Samaritan Advantage Health Plans. 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.
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 our Customer Service or ask the pharmacist.
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 to your monthly payment, there are fewer months left in the year to spread out your remaining payments.
1. Opt in through an online form.
2. Call Us: 844-368-8729.
3. Complete the enrollment form and mail it to:
Enrollment Form (English)
Samaritan Advantage Health PlansAttn: M3P Election ProcessesPO BOX 650287Dallas, TX 75265-0287
You can leave the Medicare Prescription Payment Plan at any time by contacting us at 844-368-8729. Leaving won’t affect your Medicare drug coverage and other Medicare benefits. Keep in mind:
You’ll get a reminder from us 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 monthly premium first (if you have one), so you don’t lose your drug coverage. Call us if you think we’ve made a mistake about your Medicare Prescription Payment Plan bill. If you think we made a mistake, you have the right to follow the grievance process found in your Member Handbook or Evidence of Coverage.
If you qualify for the low-income subsidy, also called “Extra Help,” with your Medicare prescription drug plan costs, your premium and costs at the pharmacy will be lower. When you join one of our plans, Medicare will tell us how much Extra Help you are getting. Then we will let you know the adjusted amount you will pay. See the table below for the monthly premiums for the current year.
If you are not getting Extra Help, you can see if you qualify by calling Social Security at 800-772-1213 (TTY users should call 800-325-0778) or visit socialsecurity.gov.
For generic/preferred multi-sourced drugs, you pay either a $0, $1.60 or $4.90 copay per prescription. For all other drugs, you pay either a $0, $4.80 or $12.15 copay per prescription.
The chart below outlines the adjusted premium amounts for 2025 based on the various low-income subsidy levels.
See also the Centers for Medicare and Medicaid Services (CMS) Best Available Evidence Policy.
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Quantity limitations and restrictions may apply.
Manage Your Monthly Drug Costs (English) – Learn the basics about the Medicare Prescription Payment Plan.
What’s the Medicare Prescription Payment Plan (English) – Get the complete details of how the Medicare Prescription Payment Plan works. Many of the details on this web page are available in this downloadable document. (12 pages)
Page Updated 6-13-2025
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