Medicare.gov

Before using this payment option

¿Cómo funciona?

Cuando obtiene una receta para un medicamento cubierto por la Parte D, no pagará a su farmacia (incluidas las farmacias de pedidos por correo y especializadas). En cambio, recibirá una factura cada mes de su plan de salud o de medicamentos.

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 your plan, 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. Learn about other programs that might save you money, if you qualify.

¿Cómo se calcula mi factura mensual?

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. Review examples of how this payment option works in different situations.

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.

En un solo año calendario (enero – diciembre), nunca pagarás más de:

  • La cantidad total que habría pagado de su bolsillo a la farmacia si no participara en esta opción de pago.
  • The out-of-pocket maximum for prescription drugs that are covered by your plan ($2,000 in 2025).

The prescription drug law caps your out-of-pocket drug costs for covered drugs 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.

¿Esto me ayudará?

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. Answer a few questions to find out if this payment option is likely to help you.

If there’s a drug that you’d like to take but it’s too expensive, and you think this payment option might spread out the cost enough to work for you, contact your plan to confirm the drug is covered and get more help.

Es posible que esta opción de pago no sea la mejor opción para usted si:

  • Sus costos anuales de medicamentos son bajos.
  • Los costos de sus medicamentos son los mismos todos los meses.
  • Está considerando inscribirse en la opción de pago a finales del año calendario (después de septiembre).
  • No desea cambiar la forma en que paga sus medicamentos.
  • You get or are eligible for Extra Help from Medicare.
  • You get or are eligible for 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.

¿Quién puede ayudarme a decidir si debo participar?

  • Your health or drug plan: Visit your plan’s website, or call your plan to get more information.
  • Programa Estatal de Asistencia con el Seguro Médico (SHIP): Visite shiphelp.org para obtener el número de teléfono de su SHIP local y obtener asesoramiento personalizado gratuito sobre seguros médicos.

¿Cómo me inscribo?

Visite el sitio web de su plan de salud o medicamentos, o llame a su plan para comenzar a participar en esta opción de pago:

  • In 2024, for 2025: If you want to participate in the Medicare Prescription Payment Plan for 2025, contact your plan now. Your participation will start January 1, 2025.
  • During 2025: Starting January 1, 2025, you can contact your plan to start participating in the Medicare Prescription Payment Plan anytime during the calendar year.

Recuerde, es posible que esta opción de pago no sea la mejor opción para usted si se registra tarde en el año calendario (después de septiembre). Esto se debe a que a medida que se agregan nuevos costos de bolsillo de medicamentos a su pago mensual, quedan menos meses en el año para distribuir sus pagos.

¿Dónde puedo obtener más información?

Visit your health or drug plan’s website, or call your plan to get more information.

¿Qué desea hacer?

Qué debo saber si estoy participando

Understand what happens once you’re using this payment option.

Will this payment option help me

Answer a few questions to get a recommendation for your specific situation.

Review Examples

Understand how this payment option spreads your costs in different situations.