What is the Medicare Prescription Payment Plan?

How it works

• At the pharmacy: you pay nothing for covered Part D drugs, including at mail-order and specialty pharmacies. Your plan tells the pharmacy you're in the payment option. You still owe the cost.
• Each month: your plan sends a bill. Medicare.gov says every plan uses the same formula: what you would have paid for any new prescriptions, plus your previous month's balance, divided by the months left in the year.
• Your premium: if your plan has one, it's billed separately. Pay it first so you don't lose coverage.
• The yearly limit still applies: you'll never pay more in a year than you would have paid the pharmacy, and never more than the $2,400 Part D out-of-pocket cap for 2027.

Who it helps, and who it doesn't

Because the bill divides your costs by the months remaining, joining early makes each bill smaller. Medicare.gov says you're most likely to benefit if you have high drug costs early in the year, such as a specialty drug that would otherwise push you to the cap in January or February. It may not help if:

• your yearly drug costs are low, or about the same every month;
• you'd be joining late in the year (after September);
• you get or qualify for Extra Help, or for a Medicare Savings Program (QMB, SLMB or QI-1, through the Florida Department of Children and Families); or
• other help already pays your drug costs. In Florida, for example, the AIDS Drug Assistance Program helps eligible people with HIV who have Medicare with medication copays and deductibles.

Medicare.gov has a short explanatory video in Spanish on its Prescription Payment Plan page, useful if you're helping a Spanish-speaking parent decide.

How to join for 2027

1. Choose your 2027 drug coverage first. Open enrollment runs through December 7, 2026. If you switch plans, your 2026 participation doesn't carry over.
2. Contact your plan. Call the number on your member card or use the plan's website. You can join at any time during the year. State retirees in the State Group Insurance Program's MA-PD plans ask that plan.
3. Watch for the confirmation letter. It explains how to pay your bills.
4. Leave whenever you like. Contact your plan; you still owe any balance, and you pay the pharmacy directly again for new fills.

If you think a bill is wrong, call your plan; you can file a grievance using the process in your Evidence of Coverage. To compare Florida drug plans for 2027, you can request a call from a licensed insurance agent or look up your drugs on PlanMatch. If cost is the problem rather than timing, check Extra Help in Florida and Medicare Savings Programs in Florida.

Related questions

Sources

• Medicare.gov — What's the Medicare Prescription Payment Plan?
• Medicare.gov — Before using this payment option (how the monthly bill is calculated)
• Medicare.gov — Using this payment option (bills, missed payments, leaving)
• CMS — CY 2027 Rate Announcement (2027 Part D out-of-pocket threshold)
• Florida Department of Health — AIDS Drug Assistance Program (ADAP)
• Florida Department of Children and Families — ESS Policy Manual, chapter 2000 (QMB, SLMB, QI-1)

More questions in this guide

• Does Florida have a state prescription assistance program for seniors?
• How many Medicare Part D plans are in Florida for 2027?
• What is the Medicare Part D out-of-pocket cap for 2027?

Part of the guide: Medicare Part D in Florida · All questions

Frequently asked questions

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