Medicare Prescription Payment Plan

No. This payment option doesn't save you money or make your drugs less expensive. However, it may help you manage your expenses by changing when and how you pay, not the total amount you pay in a year.
 

Medicare offers an “Extra Help” program (Low Income Subsidy or LIS) to pay for prescription costs for people with limited income and resources. If you qualify, you get help paying for your drug plans monthly premium, yearly deductible and prescription copayments. 

• To apply visit your Social Security office or visit ssa.gov/medicare/part-d-extra-help.
• You can also apply with your State Medical Assistance (Medicaid) office or visit Medicare.gov/ExtraHelp

If you don’t qualify for Extra Help, you can look into the following programs:

• Medicare Savings Programs run by each state. 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

Note: The programs listed above might help lower your costs, but they can't help you pay off your Medicare Prescription Payment Plan balance
 

You may be benefit from MPPP if:

• You typically have higher out-of-pocket drug costs early in the year (before September)
• You expect to meet your plan’s $2,000 Part D out-of-pocket maximum this in 2025 ( $2,100 in 2026)
• You have a large unexpected prescription drug bill that would be hard to pay all at once

You usually do NOT benefit from MPPP if:

• Your yearly drug costs are low
• Your drug costs are the same each month
• You don’t want to change how you pay for your drugs
• You’re thinking about signing up late in the calendar year (after September)
• You get help paying for your prescription drugs through programs like Extra Help from Medicare, a State Pharmaceutical Assistance Program (SPAP), or a coupon program
   

When you get a Part D prescription drug that Clover Health covers, you won't pay for it at the pharmacy right away. Instead, we will send you a bill each month. You're still responsible for paying for your drugs, even though you don't pay at the pharmacy. 

If you want to know how much a drug will cost before you pick it up, you can call Clover Health or ask your pharmacist. This payment plan can help you spread your costs each month, but it doesn't make your drugs less expensive or save you money.

Your monthly bill is based on how much your prescriptions would have cost, plus any amount you still owe from previous months, divided by how many months are left in the year. All plans use the same way to figure out your monthly payments. You can see examples of how the monthly bill is figured out on page 6 of this CMS Fact Sheet.

Your monthly payments can change, so you might not know your exact bill in advance. If you get a new prescription or refill, your future payments might go up. This is because new costs are added to your bill, and there are fewer months left in the year to pay them off.

However, in one calendar year (January to December), you will never pay more than:

• The total amount you would have paid for your drugs at the pharmacy if you weren't in this plan.
• The yearly limit for Medicare drug costs, which is $2,000 in 2025 and $2,100 in 2026

A new drug law says that everyone with Medicare drug coverage will only pay a maximum of $2,000 for their out-of-pocket drug costs in 2025, even if they don't use the Medicare Prescription Payment Plan.
 

• Online
  • Visit the Prescription Web Portal by Caremark at caremark.com/mppp
• By phone
  • Call CVS Caremark Customer service at
    • 1-855-479-3657  for PPO Plans
    • 1-844-232-2316 for HMO Plans
    • 24 hours a day, 7 days a week, TTY users can call 711
       

If you remain in the same Clover Health prescription drug plan, your participation in the Medicare Prescription Payment Plan will continue into the next plan year unless you opt out of the program. If you change your Clover Health plan at any point, you will have to opt-in again.

If you do not pay your bill within 60 days of the initial past due date, you'll be removed from the Medicare Prescription Payment Plan through Clover Health, and you'll pay the pharmacy directly for new out-of-pocket drug costs.
You're required to pay the amount you owe, but you won't pay any interest or fees, even if your payment is late.
As long as you continue to pay your plan premium (if you have one), you'll still have drug coverage through Clover Health.
 

You can leave the Medicare Prescription Payment Plan at any time by

• visiting us at caremark.com/mppp
• call us at 1-855-479-3657 for PPO Plans or 1-844-232-2316 for HMO Plans, 24 hours a day, 7 days a week, TTY users can call 711

Leaving won't affect your Medicare drug coverage and other Medicare benefits.

To learn more please see this Medicare Prescription Payment Plan Fact Sheet or visit https://www.medicare.gov/prescription-payment-plan/will-this-help-me.