¿PREFIERES ESPAÑOL? Ver el sitio web en español
Menu
Close
Be informed guide
Note
Updates to the out-of-pocket maximum for Medicare patients are only for purchases of Part D drugs, the part of Medicare that covers self-administered prescription drugs (i.e., drugs you pick up at a pharmacy).
The Medicare Prescription Payment Plan offers patients the option to pay out-of-pocket prescription drug costs in the form of capped monthly payments, instead of all at once at the pharmacy!
Patients can opt-in during open enrollment, or anytime during the plan year
The plan allows you to spread out-of-pocket costs over the course of the remaining year, rather than pay them all at once
Patients pay $0 to the pharmacy and will instead be billed monthly by their Part D drug plan
While the program will be available to all patients with Medicare Part D coverage, patients most likely to benefit from the program include those who expect high prescription cost earlier in the plan year. In this case, opting-in can spread those costs out throughout the year and give more time to pay in smaller chunks.
All beneficiaries can opt-into the Prescription Payment Plan directly through their Part D or Medicare Advantage plan during open enrollment or at any time during the plan year.
There are three main ways someone can sign up:
This example shows the impact of Part D changes on patient OOP costs in 2024 versus 2025 for a standard benefit Medicare Part D patient.
2024
2025
First Fill in January
First Fill in January
First Fill in June
Without Payment Plan
With Payment Plan
Without Payment Plan
With Payment Plan
January
~$3,300
$2,000
$167
--
February
--
--
$167
--
March
--
--
$167
--
April
--
--
$167
--
May
--
--
$167
--
June
--
--
$167
$2,000
$286
--
--
$167
--
$286
August
--
--
$167
--
$286
September
--
--
$167
--
$286
October
--
--
$167
--
$286
November
--
--
$167
--
$286
December
--
--
$167
--
$286
Total
$3,300
$2,000
2024
First Fill in January
January
~$3,300
Febuary
--
March
--
April
--
May
--
June
--
July
--
August
--
September
--
Octomber
--
November
--
December
--
Total
$3,300
2025
First Fill in January
With Payment Plan
Without Payment Plan
January
$2,000
$167
February
--
$167
March
--
$167
April
--
$167
May
--
$167
June
--
$167
July
--
$167
August
--
$167
September
--
$167
Octomber
--
$167
November
--
$167
December
--
$167
Total
$2,000
2025
First Fill in June
With Payment Plan
Without Payment Plan
January
--
Febuary
--
March
--
April
--
May
--
June
$2000
$286
July
--
$286
August
--
$286
September
--
$286
Octomber
--
$286
November
--
$286
December
--
$286
Total
$2,000
Please note that in 2025 a patient’s OOP cost and monthly payments, if they sign up for a payment plan, will vary depending on their mix of drugs and the month in which drugs are filled, but patient OOP costs will not exceed $2,000
Low-Income Subsidy (LIS), or Extra Help, helps people with limited income and resources to lower or cut Part D costs:
Drug Plan Premium
Annual deductible
Copay for brand-name drug & $4.90 copay for generic drugs
Medicare.gov/prescription-payment-plan, or call 1-800-MEDICARE (1-800-633-4227)
Patients can visit their plan’s website or call them directly.
Visit ssa.gov/extrahelp for more information on if you qualify for Extra Help and how to apply. You can also apply over the phone or request an application by calling Social Security at 1-800-325-0778
https://webfiles.digitalpfizer.com/how_to_pick_a_medicare_plan_interactive/index.html
For help with all of these topics, and more, visit SHIP
Disclaimer: The information on this site is intended for U.S. residents only and is provided purely for educational purposes. Health, legal, regulatory, insurance, or financial related-information provided here is not comprehensive and is not intended to provide individual guidance or replace discussions with a healthcare provider, attorney, or other experts. All decisions must be made with your advisers considering your unique situation. © Triage Cancer & Pfizer Inc. 2024
Example
Example
Example
about changes to Medicare Part D in 2025 that will cap out-of-pocket (OOP) costs for patients
from MyHealthcareFinances for opting-into the Medicare Prescription Payment Plan
