Medicare Prescription Payment Plan
What's the Medicare Prescription Payment Plan?
The Medicare Prescription Payment Plan is a new payment option in the prescription drug law. It 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). Starting in 2026, 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. All plans offer this payment option and participation is voluntary.
What to know before participating
- How does it work?
- How is my monthly bill calculated?
- Will this help me?
- Who can help me decide if I should participate?
- How do I sign up?
What to know if I'm participating
- What happens after I sign up?
- How do I pay my bill?
- What happens if I don't pay my bill?
- How do I leave?
- What happens if I change health or drug plans?
What programs can help lower my costs?
Where can I get more information?
Examples of how a monthly bill is calculated (PDF)
How does it work?
When you fill a prescription for a drug covered by Part D, you won't pay your pharmacy (including mail order and specialty pharmacies) at the time you pick it up. Instead, you'll get a bill each month from AmeriHealth Caritas VIP Care.
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, ask the pharmacist or call Pharmacy Member Service at 1-844-657-2255 (TTY 711).
This payment option might help you manage your monthly expenses, but it doesn't save you money or lower your drug costs. See section What programs can help lower my costs? for additional information.
How is my monthly bill calculated?
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.
View examples (PDF) of how the monthly bill is calculated.
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 Medicare drug coverage annual out-of-pocket maximum ($2,100 in 2026).
The prescription drug law caps your out-of-pocket drug costs 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.
Will this help me?
Will this help me?
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. Go to Medicare.gov/prescription-payment-plan/will-this-help-me to answer a few questions and find out if you're likely to benefit from this payment option.
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 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.
Learn about programs that can help lower your costs.
Who can help me decide if I should participate?
Member Services: Call Member Services at 1-833-433-3767 (TTY 711) Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31. We can explain how the Medicare Prescription Payment Plan works with your coverage and answer questions about your prescriptions.
If you need a prescription right away: Call Member Services to discuss your options.
Medicare: Visit Medicare.gov/prescription-payment-plan to learn more about this payment option and if it might be a good fit for you.
State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling.
How do I sign up?
You can sign up in one of the following ways
- Online: Log in to your secure member account and use the enrollment tool.
- By mail: Complete the Medicare Prescription Payment Plan Election Request Form (PDF) and mail it to:
AmeriHealth Caritas VIP Care
P.O. Box 7139
London, KY 40742 - By phone: Call Member Services at 1-833-433-3767 (TTY 711), Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31
When can you sign up:
You can enroll in the Medicare Prescription Payment Plan at any time after your enrollment into our plan has been accepted.
- New members enrolling before their plan effective date: Your Medicare Prescription Payment Plan participation will begin on the same day your plan coverage starts.
- New members enrolling after their plan effective date: Your Medicare Prescription Payment Plan participation will begin on the date your completed enrollment request is received and approved.
- Existing Medicare Prescription Payment Plan members: Your participation will continue into the new plan year automatically unless you choose to opt out.
Note: Your Medicare Prescription Payment Plan cannot be earlier than the start date of your plan enrollment.
Important to know
This payment option may not be the best choice for you if you sign up late in the calendar year (after September). This is because as new out-of-pocket drug costs are added to your monthly payment. Since there are only a few months left in the year, this may make your monthly bills higher.
Automatic continuation
If you are already enrolled in Medicare Prescription Payment Plan and remain in the same plan for the upcoming year, your participation in the program will continue into the next year unless you request to opt out.
If you change to a different plan within our company, your enrollment in the Medicare Prescription Payment Plan does not automatically carry over. You must complete a new enrollment request for your new plan in order to participate.
What to know if I'm participating
What happens after I sign up?
After you submit your election request form, our team will review it. If everything is complete, we’ll approve your enrollment and send you a letter confirming your participation in the Medicare Prescription Payment Plan. If information is missing or needs clarification, we’ll let you know and you may need to resubmit or provide additional information. In rare cases your request may be denied if eligibility requirements aren’t met.
- Once approved, you’re enrolled in the Medicare Prescription Payment Plan – your prescriptions for covered drugs will be processed at the pharmacy as usual. You won’t pay the pharmacy directly for these prescriptions; instead, we will send you a monthly bill for the total cost of your prescriptions. Being in the payment plan does not reduce or waive your drug costs – you are still responsible for paying for your medications.
- Each month, we’ll send you a statement with the amount you owe for your prescriptions, the due date (the 28th of each month), and easy instructions for how to make your payment. If you don’t pay your monthly bill, you may be removed from the Medicare Prescription Payment Plan, but not from AmeriHealth Caritas VIP Care. See “What happens if I don’t pay my bill?" for more details.
How do I pay my bill?
How do I pay my Medicare Prescription Payment Plan monthly bill?
We offer several easy ways to make your Medicare Prescription Payment Plan payment:
- Pay online
- Pay by phone
- Call our 24/7 Automated Payment Line at 1-866-712-6725. Follow the instructions to make a payment by credit card over the phone.
- Pay by mail:
- If you prefer, you can send a check by mail, make sure to write your member ID in the memo section of the check.
- Please include your payment coupon.
- Do not use staples or paper clips to hold your payment to your payment coupon.
Make your check, money order, or cashier’s check payable to AmeriHealth Caritas VIP Care Delaware.
Please note: Do not send cash through the mail. - Mail to:
AmeriHealth Caritas VIP Care - DE
P.O. Box 830796
Philadelphia, PA 19182-0796
Notice to members sending checks
Payments received by 3 p.m. will be credited as of the day it is received. Payments received after 3 p.m. will not be credited to your account until the next business day. Checks must be from a U.S. bank and paid in U.S. dollars.
By sending a check, you agree to allow us to electronically take funds directly from your account using the information on your check, acting as a one-time electronic transfer, or to process the payment as a standard check transaction. If we electronically transfer funds, the money may be taken from your account on the same day we receive your check. You will not get the check back from your bank.
Important reminders
- Payment due date: Your payment is due on the 28th of each month.
Need help? If you have questions about your payment, call 1-866-712-6725 (TTY 711); Monday through Thursday, 8 a.m.- 8 p.m., and Friday, 8 a.m. - 4:30 p.m. ET.
What happens if I don't pay my bill?
You'll get a reminder if you miss a payment. If you still don't pay your bill within a two-month grace period, 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 AmeriHealth Caritas VIP Care.
Call 1-866-712-6725 (TTY 711), Monday through Thursday, 8 a.m.- 8 p.m., and Friday, 8 a.m. - 4:30 p.m. ET, if you think we 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 (PDF) (pending state approval).
How do I leave?
You can leave the Medicare Prescription Payment Plan at any time by calling member services Leaving won't affect your enrollment in AmeriHealth Caritas VIP Care. 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.
What happens if I change health or drug plans?
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.
What programs can help lower my costs?
If you have limited income and resources, find out if you're eligible for one of these programs:
- Extra Help: A Medicare program that helps pay your Medicare drug costs. Visit ssa.gov/medicare/part-d-extra-help to find out if you qualify and apply. You can also apply with your State Medical Assistance (Medicaid) office. Visit Medicare.gov/ExtraHelp to learn more.
- Medicare Savings Programs: State-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance. Visit Medicare.gov/medicare-savings-programs to learn more.
- State Pharmaceutical Assistance Programs (SPAPs): Programs that might include coverage for your Medicare drug plan premiums and/or cost sharing. SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit. Visit go.medicare.gov/spap to learn more.
- Manufacturer Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs): Programs from drug manufacturers to help lower drugs costs for people with Medicare. Visit go.medicare.gov/pap to learn more.
Many people qualify for savings and don't realize it. Visit Medicare.gov/basics/costs/ for help, or contact your local Social Security office to learn more. Find your local Social Security office at ssa.gov/locator/.
Where can I get more information?
- Contact Member Services at 1-833-433-3767 (TTY 711), Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31
- Medicare: Visit Medicare.gov/prescription-payment-plan, or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, seven days a week. TTY users can call 1-877-486-2048.
Examples of how a monthly bill is calculated (PDF)
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