The Medicare Prescription Payment Plan is a new payment option offered by Medicare Part D 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 Part D drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. If you select this payment option, each month you’ll continue to pay your Medicare Part B premium and plan premium (if you have one), and you’ll get a bill from us to pay for the cost share of your prescription drugs (instead of paying the pharmacy). All plans offer this payment option and participation is voluntary. There’s no cost to participate in the Medicare Prescription Payment Plan.

To enroll in the Medicare Prescription Payment Plan, login to your Hally account through the MyChart app or at Hally.com. Once logged in, select the menu option and navigate to and select the Prescription Benefits Program option. You will now be directed to the Optum Rx website where you will be required to register your account information prior to accessing any pharmacy benefit information.

After your registration is complete, you will be directed to your Optum Rx account and can select the “Medicare Prescription Payment Plan” option. Selecting this option will allow you to Opt-In to the program, manage your payment options, view your coverage details, and review any notifications. Additionally, you can access your online account to Opt-Out of the program at any time.

To Opt-In or Opt-Out of the program by phone, please call us using the phone number on your member ID card. To Opt-In to the program by mail, please download our online enrollment formonline enrollment form and mail the form to:

FirstCarolinaCare New Hanover Health Advantage
Application Processing Center:
3310 Field South Dr.
Champaign, IL 61822

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.

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 total amount you would have paid out of pocket to the pharmacy if you weren’t participating in this payment option.
• The Medicare Part D drug coverage annual out-of-pocket maximum ($2,000 in 2025).

For more specific examples of how the monthly bill would be calculated click here.

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.

The Medicare Prescription Payment Plan is free to join and there are no fees or interest charged when using the program. The Medicare Prescription Payment plan might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. Your total out-of-pocket prescription drug costs, including deductibles, copayments and coinsurance associated with the pharmacy benefit, will not change because of the program. The only difference is how and when you pay for your prescription drug costs (which become monthly payments to the plan instead of at-the-time-of-sale payments to the pharmacy). You will still have access to the same network of pharmacies, enrollment in this plan does not require you to change pharmacies.

Each month, we will send you a bill with the amount you owe for your prescriptions, when it’s due, and information on how to make a payment. You’ll get a separate bill for your monthly plan premium (if you have one).

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 Part D drug plan.

You can enroll by logging into your Hally member account or by calling us using the phone number on your member ID card. We will review your enrollment request and respond to you within 24 hours with:

• An approval of the request and effective date when the individual starts in the Medicare Prescription Payment Plan
• A request for additional information
• A denial of the request through a written notice of denial.

Upon approval, 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. If you want to know what your drug will cost before you pick it up, contact our customer service team or contact your pharmacy.

If you filled an urgent prescription and had to pay for it because you had not yet enrolled or your enrollment into the Medicare Prescription Payment Program was not yet effective, you may be eligible for assistance. We may be able to offer a retroactive election into the program if:

• You believe that any delay in filling the prescription(s) due to the 24 hours timeframe required to process your request to opt-in may seriously jeopardize your life, health, or ability to regain maximum function
• You request a retroactive election within 72 hours of the date and time the urgent prescription was filled.

If you have questions, please call us, using the phone number on your member ID card.

If you have a complaint or dispute related to the Medicare Prescription Payment Plan, you have the right to file a grievance. Follow the grievance process found in your Member Handbook or Evidence of Coverage.

To learn more about the Medicare Prescription Payment Plan:

• Review the information on our website, or call us using the phone number on your member ID card.
• Medicare: Visit Medicare.gov/prescription-payment-plan or call 1-800-MEDICARE (1-800-633-4227).
• State Health Insurance Assistance Program (SHIP): Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling.

The Low Income Subsidy (LIS) program, also known as Extra Help, assists Medicare beneficiaries with limited income and resources afford their prescription drug costs. The program helps beneficiaries with their Part D costs including deductibles and cost sharing.

Eligibility for the Extra Help is based on income and resource thresholds. The program provides varying levels of assistance to beneficiaries at different income and asset levels. The Inflation Reduction Act expanded eligibility for the program. The expansion went into effect in 2024 and Medicare beneficiaries with incomes up to 150% of poverty and resources are eligible for the program.

Those who qualify can significantly reduce their out-of-pocket costs, ensuring better access to necessary medications and improved health outcomes. The Extra Help program is likely to be more beneficial than participation in the Medicare Prescription Payment Plan. For more information and to see if you qualify for Extra Help or call us using the phone number on your member ID card.