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 from Mass General Brigham Health Plan.
• Even though you won’t pay for your drugs at the pharmacy, you’re still responsible for the costs.
• This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.
• In most cases you must opt into the program before you fill a prescription. The payment plan does not apply to prescriptions that you have already picked up and paid for.

How is my monthly bill calculated?

• Your monthly bill is based on what you would have paid for any prescriptions you get, the number of months left in the year, and whether you had an outstanding balance from the previous month.  The amount you owe may change from month to month.  For more information about how each monthly amount is calculated, refer to the examples below.
• 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 ($2,000 in 2025).
• 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 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.

How do I sign up?

• You can opt into this payment program online through the online request form. You can also print the Participation Request form and follow the included instructions to mail your completed form.
  • In 2024, for 2025: If you want to participate in the Medicare Prescription Payment Plan for 2025, contact Mass General Brigham Health Plan as early as 10/15/24. Your participation will start January 1, 2025.
  • During 2025: Starting January 1, 2025, you can contact Mass General Brigham Health Plan 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.

How do I pay my bill?

• You can pay: 
  • Online, by credit or debit card.
  • Through mail, by check.

Mass General Brigham Health Plan
Medicare Prescription Payment Plan 
P.O. Box 7 
Pittsburgh, PA 15230

• If you have questions about your payment, call us at 866-209-2372, 24/7. TTY users can call 711. 

What happens if I don’t pay my bill?

• You’ll get a reminder 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. If you’re removed from the Medicare Prescription Payment Plan, you’ll still be enrolled in your Medicare health or drug plan.
• Always pay your health or drug plan monthly premium first (if you have one).
• Call Mass General Brigham Health Plan 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.

How do I leave?

• You can leave the Medicare Prescription Payment Plan at any time by contacting Mass General Brigham Health Plan. 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 continue to 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 programs can help lower my costs?

• You may be eligible for programs that can help lower your costs, like: 
  • Extra Help: A Medicare program that helps pay your Medicare drug costs if you have limited income and resources. This program expanded to include beneficiaries with incomes up to 150% of the federal poverty limit who meet certain resource standards. Visit secure.ssa.gov/i1020/start to find out if you qualify and apply. You can also apply with your state’s Medicaid office. Visit Medicare.gov/basics/costs/help/drug-costs to learn more. For those who qualify, the Extra Help program is likely more advantageous than participation in the Medicare Prescription Payment Plan.
  • Medicare Savings Program: A state-run program that helps people with limited income and resources pay some or all of their Medicare premiums, deductibles, and coinsurance. Visit Medicare.gov/medicare-savings-programs to learn more.
  • State Pharmaceutical Assistance Program (SPAP): A program that may 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’s Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs)): A program 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/help, or contact your local Social Security office to learn more. Find your local Social Security office at secure.ssa.gov/ICON/main.jsp.
• Note: The programs listed above may help lower your costs, but they can’t help you pay off your Medicare Prescription Payment Plan balance.

Where can I get more information?

• Mass General Brigham Health Plan: Call our Customer Service team at 855-833-3668 (TTY users call: 711).
  Hours:
October 1 – March 31, call seven days a week, 8 am–8 pm Eastern Time.
April 1 – September 30, Monday – Friday, 8 am–8 pm Eastern time.
• Medicare: Visit Medicare.gov/prescription-payment-plan, or call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.