Medicare Prescription Payment Plan

At Blue Cross and Blue Shield of Nebraska, we want to make sure you stay informed about what matters to you.

What is the Medicare Prescription Payment Plan?

The Medicare Prescription Payment Plan is a new payment option 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 can use this payment option. If you select this payment option, each month you’ll get a bill to pay for your prescription drugs (instead of paying the pharmacy).

How much does it cost to participate?

There’s no cost to participate in the Medicare Prescription Payment Plan.

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). Instead, you’ll get a bill each month.

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, call us at 888-488-9850 (TTY: 711) or ask the pharmacist. This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.

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. 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.

Will this help me?

It depends on your situation. This payment option may not be the best choice for you if:

• Your yearly drug costs are low.
• You don’t want to change how you pay for your drugs.
• You get or are eligible for Extra Help from Medicare.
• You get help paying for your drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP), a coupon program, or other health coverage.

How do I sign up?

In 2024, for 2025: If you want to participate in the Medicare Prescription Payment Plan for 2025, contact us now. Your participation will start Jan. 1, 2025.

In some instances, you may be eligible for a retroactive election if:

• a delay in filling your prescription(s) due to the 24 hours timeframe required to process your request to enroll in the in the Medicare Prescription Payment Plan may seriously jeopardize your life, health, or ability to regain maximum function; and
• you request retroactive election within 72 hours of the date and time the urgent prescription claim(s) were adjudicated.

If you have questions around Medicare Prescription Payment Plan retroactive election, please contact us at any time at 888-488-9850 (TTY: 711).

During 2025: Starting Jan. 1, 2025, you can contact us to start participating in the Medicare Prescription Payment Plan anytime during the calendar year.

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.

When you sign in, you will automatically be taken to your enrollment form. If you do not have a member account, you can either create a new account, or you can access an enrollment form to print.

Enroll Now

What happens after I sign up?

Once we review your participation request, we’ll send you a letter confirming your participation in the Medicare Prescription Payment Plan. Then:

1. When you get a prescription for a drug covered by Part D, we will automatically let the pharmacy know that you’re participating in this payment option, and you won’t pay the pharmacy for the prescription. Even though you won’t pay for your drugs at the pharmacy, you’re still responsible for the costs.
2. Each month, you’ll receive a bill with the amount you owe for your prescriptions, when it’s due, and information on how to make a payment.

What happens if I don’t pay my bill?

You’ll get a reminder from us 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 your Medicare health or drug plan. Call us 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, or you can access our grievance procedures.

Access Our Grievance Procedures

How do I leave the program?

You can leave the Medicare Prescription Payment Plan at any time by contacting us at 888-488-9850 (TTY: 711). Leaving won’t affect your Medicare drug coverage and other Medicare benefits.

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.

Where can I get more information?

For more information about this program as well as detailed examples, you can access the Medicare Prescription Payment Plan Fact Sheet or visit Medicare.gov/Prescription-Payment-Plan.