Medicare Prescription Payment Plan
Medicare
Prescription
Payment Plan
WHAT IS 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). Starting in 2025,
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.
If you select this payment option, each month you’ll continue to pay Astiva Health premium (if you have one), and you’ll get a bill
from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the
Medicare Prescription Payment Plan.
WHAT TO KNOW BEFORE PARTICIPATING
How does it work?
This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. Go to the section below on “What programs can help lower my costs?” to learn about Extra Help and other programs that might save you money, if you qualify.
How is my monthly bill 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 prescription drug law caps your out-of-pocket drug costs at $2,000 in 2025. This is true for everyone with Medicare drug coverage, even if you don’t participate in the Medicare Prescription Payment Plan.
WILL THIS PROGRAM HELP ME OR
AM I LIKELY TO BENEFIT FROM THE
MEDICARE PRESCRIPTION PAYMENT PLAN?
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.
This payment option may not be the best choice for you if:
WHO CAN HELP ME DECIDE IF I SHOULD PARTICIPATE?
HOW DO I SIGN UP?
Visit your Astiva Health website, or call us at Astiva Health Member Services at 1-866-688-9021 8:00 AM - 8:00 PM, TTY 711 to start participating in this payment option:
Remember, 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, there are fewer months left in the year to spread out your payments.
MEDICARE PRESCRIPTION PAYMENT ELECTION FORMWHAT TO KNOW IF I’M PARTICIPATING
What happens after I sign up?
Once Astiva Health reviews your participation request, we will send you a letter confirming your participation in the Medicare Prescription Payment Plan. Then:
HOW DO I PAY MY BILL?
After
Astiva Health
approves your participation in the Medicare Prescription Payment Plan, you’ll get a letter from
Astiva Health
with information about how to pay your bill.
PAYMENT OPTIONS AVAILABLE: Check or Money Order.
WHAT HAPPENS IF I DON’T PAY MY BILL?
You’ll get a reminder from
Astiva Health
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
Astiva Health.
Always pay your health or drug plan monthly premium first (if you have one), so you don’t lose your drug coverage.
If you’re concerned about paying both your monthly plan premium and Medicare Prescription Payment Plan bills, go to the Section below on
“What programs can help lower my costs?”
for information about programs that can help lower your costs.
Call
Astiva Health Member Services at 1-866-688-9021 8:00 AM - 8:00 PM, TTY 711
, if you think
Astiva Health
made a mistake about your Medicare Prescription Payment Plan bill. If you think
Astiva Health
made a mistake, you have the right to follow the grievance process found in your Member Handbook or Evidence of Coverage.
HOW DO I LEAVE?
You can leave the Medicare Prescription Payment Plan at any time by contacting Astiva Health Member Services at 1-866-688-9021 8:00 AM - 8:00 PM, TTY 711 . Leaving won’t affect your Medicare drug coverage and other Medicare benefits. Keep in mind:
WHAT HAPPENS IF I CHANGE HEALTH OR DRUG PLANS?
If you leave
Astiva Health
, 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:
WHERE CAN I GET MORE INFORMATION?
Additionally, CMS has released a public-facing webpage, available at https://www.medicare.gov/prescription-payment-plan , that includes information about the Medicare Prescription Payment Plan and an interactive wizard to help Part D enrollees determine if the payment option might help them.
1-866-688-9021
Calls to this number are free.
8:00 AM - 8:00 PM
Member Services also has free language interpreter services available for non-English speakers.
711
Calls to this number are free.
8:00 AM - 8:00 PM
1-949-522-8553
Astiva Health
765 The City Drive South, #200
Orange, CA 92868
www.astivahealth.com/mppp
EXAMPLES OF HOW A MONTHLY BILL IS CALCULATED
Example 1:
You take several high-cost drugs that have a total out-of-pocket cost of $500 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
First, we figure out your “maximum possible payment” for the first month:
$2,000 [annual out-of-pocket maximum]
-$0 [no out-of-pocket costs before using this payment option]
= $2,000
12 [remaining months in the year]
Then, we figure out what you’ll pay for January:
For February and the rest of the months left in the year, we calculate your payment differently:
$333.33 [remaining balance] + $500 [new costs]
= $833.33
11 [remaining months in the year]
We’ll calculate your March payment like we did for February:
$757.57 [remaining balance] + $500 [new costs]
= $1,257.57
10 [remaining months in the year]
In April, when you refill your prescriptions again, you’ll reach the annual out-of- pocket maximum for the year ($2,000 in 2025). You’ll continue to pay what you already owe and get your prescription(s), but after April you won’t add any new out- of-pocket costs for the rest of the year
$1,131.81 [remaining balance] + $500 [new costs]
= $1,631.81
9 [remaining months in the year]
Even though your payment varies each month, by the end of the year, you’ll never pay more than:
Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium (if you have one) each month.
This is when you started participating in this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently.
This month you reached the annual out-of-pocket maximum ($2,000 in 2025). You’ll have no new out-of-pocket drug costs for the rest of the year
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe
You’ll pay the same total amount for the year, even if you don’t use this payment option.
If you’re concerned about paying $500 each month from January to April, this payment option will help you manage your costs. If you prefer to pay $500 each month for 4 months and then pay $0 for the rest of the year, this payment option might not be right for you. Contact your health or drug plan for personalized help.
EXAMPLES OF HOW A MONTHLY BILL IS CALCULATED
Example 2:
You take several drugs that have a total out-of-pocket cost of $80 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
First, we figure out your “maximum possible payment” for the first month:
$2,000 [annual out-of-pocket maximum]
-$0 [no out-of-pocket costs before using this payment option]
= $2,000
12 [remaining months in the year]
Then, we figure out what you’ll pay for January:
For February and the rest of the months left in the year, we calculate your payment differently:
$0 [remaining balance] + $80 [new costs]
= $80
11 [remaining months in the year]
We’ll calculate your March payment like we did for February:
$72.73 [remaining balance] + $80 [new costs]
= $152.73
10 [remaining months in the year]
Even though your payment varies each month, by the end of the year,
you’ll never pay more than:
Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium (if you have one) each month.
This is when you started using this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently.
You’ll pay the same total amount for the year, even if you don’t use this payment option.
Depending on your specific circumstances, you might not benefit from using this payment option due to the higher payments that start in September. Contact your health or drug plan for personalized help.
EXAMPLES OF HOW A MONTHLY BILL IS CALCULATED
Example 3:
You pay $4 every month in out-of-pocket costs for a prescription you use regularly.
In April 2025, you need a new one-time prescription that costs $613, so your total out-of-pocket costs in April are $617. That same month, before you fill your prescriptions, you decide to participate in the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
First, we figure out your “maximum possible payment” for the first month:
$2,000 [annual out-of-pocket maximum]
-$12 [no out-of-pocket costs before using this payment option]
= $1,988
9 [remaining months in the year]
Then, we figure out what you’ll pay for April:
For May and the rest of the months left in the year, we calculate your payment differently:
$396.11[remaining balance] + $4 [new costs]
= $400.11
8 [remaining months in the year]
Your payments will vary throughout the year. That’s because you’re adding drug costs during the year, but you have fewer months left in the year to spread your payments across.
By the end of the year, you’ll never pay more than:
Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium (if you have one) each month.
You’ll pay the same total amount for the year, even if you don’t use this payment option.
If you’re concerned about paying $617 in April, this payment option will help you spread your costs across monthly payments that vary throughout the year. If you’re concerned about higher payments later in the year, this payment option might not be right for you. Contact your health or drug plan for personalized help.
Medicare
Prescription
Payment Plan
WHAT IS 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). Starting in 2025,
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.
If you select this payment option, each month you’ll continue to pay Astiva Health premium (if you have one), and you’ll get a bill
from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the
Medicare Prescription Payment Plan.
WHAT TO KNOW BEFORE PARTICIPATING
How does it work?
This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. Go to the section below on “What programs can help lower my costs?” to learn about Extra Help and other programs that might save you money, if you qualify.
How is my monthly bill 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 prescription drug law caps your out-of-pocket drug costs at $2,000 in 2025. This is true for everyone with Medicare drug coverage, even if you don’t participate in the Medicare Prescription Payment Plan.
WILL THIS PROGRAM HELP ME OR
AM I LIKELY TO BENEFIT FROM THE
MEDICARE PRESCRIPTION
PAYMENT PLAN?
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.
This payment option may not be the best choice for you if:
WHO CAN HELP ME DECIDE IF I SHOULD PARTICIPATE?
HOW DO I SIGN UP?
Visit your Astiva Health website, or call us at Astiva Health Member Services at 1-866-688-9021 8:00 AM - 8:00 PM, TTY 711 to start participating in this payment option:
Remember, 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, there are fewer months left in the year to spread out your payments.
WHAT TO KNOW IF I’M PARTICIPATING
What happens after I sign up?
Once Astiva Health reviews your participation request, we will send you a letter confirming your participation in the Medicare Prescription Payment Plan. Then:
HOW DO I PAY MY BILL?
After
Astiva Health
approves your participation in the Medicare Prescription Payment Plan, you’ll get a letter from
Astiva Health
with information about how to pay your bill.
PAYMENT OPTIONS AVAILABLE: Check or Money Order.
WHAT HAPPENS IF I DON’T PAY MY BILL?
You’ll get a reminder from
Astiva Health
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
Astiva Health.
Always pay your health or drug plan monthly premium first (if you have one), so you don’t lose your drug coverage.
If you’re concerned about paying both your monthly plan premium and Medicare Prescription Payment Plan bills, go to the Section below on
“What programs can help lower my costs?”
for information about programs that can help lower your costs.
Call
Astiva Health Member Services at 1-866-688-9021 8:00 AM - 8:00 PM, TTY 711
, if you think
Astiva Health
made a mistake about your Medicare Prescription Payment Plan bill. If you think
Astiva Health
made a mistake, you have the right to follow the grievance process found in your Member Handbook or Evidence of Coverage.
HOW DO I LEAVE?
You can leave the Medicare Prescription Payment Plan at any time by contacting Astiva Health Member Services at 1-866-688-9021 8:00 AM - 8:00 PM, TTY 711 . Leaving won’t affect your Medicare drug coverage and other Medicare benefits. Keep in mind:
WHAT HAPPENS IF I CHANGE HEALTH OR DRUG PLANS?
If you leave
Astiva Health
, 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:
WHERE CAN I GET MORE INFORMATION?
Additionally, CMS has released a public-facing webpage, available at https://www.medicare.gov/prescription-payment-plan , that includes information about the Medicare Prescription Payment Plan and an interactive wizard to help Part D enrollees determine if the payment option might help them.
1-866-688-9021
Calls to this number are free.
8:00 AM - 8:00 PM
Member Services also has free language interpreter services available for non-English speakers.
711
Calls to this number are free.
8:00 AM - 8:00 PM
1-949-522-8553
Astiva Health
765 The City Drive South, #200
Orange, CA 92868
www.astivahealth.com/mppp
EXAMPLES OF HOW A MONTHLY BILL IS CALCULATED
Example 1:
You take several high-cost drugs that have a total out-of-pocket cost of $500 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
First, we figure out your “maximum possible payment” for the first month:
$2,000 [annual out-of-pocket maximum]
-$0 [no out-of-pocket costs before using this payment option]
= $2,000
12 [remaining months in the year]
Then, we figure out what you’ll pay for January:
For February and the rest of the months left in the year, we calculate your payment differently:
$333.33 [remaining balance] + $500 [new costs]
= $833.33
11 [remaining months in the year]
We’ll calculate your March payment like we did for February:
$757.57 [remaining balance] + $500 [new costs]
= $1,257.57
10 [remaining months in the year]
In April, when you refill your prescriptions again, you’ll reach the annual out-of- pocket maximum for the year ($2,000 in 2025). You’ll continue to pay what you already owe and get your prescription(s), but after April you won’t add any new out- of-pocket costs for the rest of the year
$1,131.81 [remaining balance] + $500 [new costs]
= $1,631.81
9 [remaining months in the year]
Even though your payment varies each month, by the end of the year, you’ll never pay more than:
Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium (if you have one) each month.
This is when you started participating in this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently.
This month you reached the annual out-of-pocket maximum ($2,000 in 2025). You’ll have no new out-of-pocket drug costs for the rest of the year
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe
You’ll pay the same total amount for the year, even if you don’t use this payment option.
If you’re concerned about paying $500 each month from January to April, this payment option will help you manage your costs. If you prefer to pay $500 each month for 4 months and then pay $0 for the rest of the year, this payment option might not be right for you. Contact your health or drug plan for personalized help.
EXAMPLES OF HOW A MONTHLY BILL IS CALCULATED
Example 2:
You take several drugs that have a total out-of-pocket cost of $80 each month. In January 2025, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
First, we figure out your “maximum possible payment” for the first month:
$2,000 [annual out-of-pocket maximum]
-$0 [no out-of-pocket costs before using this payment option]
= $2,000
12 [remaining months in the year]
Then, we figure out what you’ll pay for January:
For February and the rest of the months left in the year, we calculate your payment differently:
$0 [remaining balance] + $80 [new costs]
= $80
11 [remaining months in the year]
We’ll calculate your March payment like we did for February:
$72.73 [remaining balance] + $80 [new costs]
= $152.73
10 [remaining months in the year]
Even though your payment varies each month, by the end of the year,
you’ll never pay more than:
Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium (if you have one) each month.
This is when you started using this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently.
You’ll pay the same total amount for the year, even if you don’t use this payment option.
Depending on your specific circumstances, you might not benefit from using this payment option due to the higher payments that start in September. Contact your health or drug plan for personalized help.
EXAMPLES OF HOW A MONTHLY BILL IS CALCULATED
Example 3:
You pay $4 every month in out-of-pocket costs for a prescription you use regularly.
In April 2025, you need a new one-time prescription that costs $613, so your total out-of-pocket costs in April are $617. That same month, before you fill your prescriptions, you decide to participate in the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
First, we figure out your “maximum possible payment” for the first month:
$2,000 [annual out-of-pocket maximum]
-$12 [no out-of-pocket costs before using this payment option]
= $1,988
9 [remaining months in the year]
Then, we figure out what you’ll pay for April:
For May and the rest of the months left in the year, we calculate your payment differently:
$396.11[remaining balance] + $4 [new costs]
= $400.11
8 [remaining months in the year]
Your payments will vary throughout the year. That’s because you’re adding drug costs during the year, but you have fewer months left in the year to spread your payments across.
By the end of the year, you’ll never pay more than:
Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium (if you have one) each month.
You’ll pay the same total amount for the year, even if you don’t use this payment option.
If you’re concerned about paying $617 in April, this payment option will help you spread your costs across monthly payments that vary throughout the year. If you’re concerned about higher payments later in the year, this payment option might not be right for you. Contact your health or drug plan for personalized help.
