The Medicare Prescription Payment Plan is a new payment option in the prescription drug law 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). This is a new program offered by all Part D plans and is voluntary to join.Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option.
To learn more about the Medicare Prescription Payment Plan, read the Medicare Fact Sheet:
https://www.medicare.gov/publications/12211-whats-the-medicare-prescription-payment-plan.pdf
Extra Help (also known the Low-Income Subsidy (LIS) program) is a Medicare program that helps pay your Medicare drug costs as an additional or alternative avenue for addressing prescription drug costs. Visit ssa.gov/medicare/part-d-extra-help to find out if you qualify and apply. You can also apply with your State Medical Assistance (Medicaid) office. Visit Medicare.gov/ExtraHelp to learn more. LIS enrollment, for those who qualify, is likely to be more advantageous than participation in the Medicare Prescription Payment Plan. Medicare expanded the Extra Help program under Medicare Part D to 150% of the federal poverty level starting in 2024.
If you have certain urgent prescription fill(s) for which you paid the associated cost sharing before your program election was received and processed by us, we will make your program participation effective retroactively. A retroactive election will be processed if all the following conditions are met:
● You believe that any delay in filling the prescription(s) due to the 24 hours timeframe required to process your request to opt in in 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 claim(s) were adjudicated.
● Your participation in the Medicare Prescription Payment Plan will end on December 31. To continue with the program in the new plan year, you must opt in again for a January 1 start date.
Terms and Conditions
● This is an optional program. If eligible and you choose to participate but fail to comply with program terms and conditions, Troy Medicare reserves all rights under the law.
● Troy Medicare will send a monthly bill to you for any prescription cost sharing that you may owe.
● If you leave the Medicare Prescription Payment Plan, you will resume paying the pharmacy directly for your Part D prescriptions after leaving the Medicare Prescription Payment Plan.
● Troy Medicare reserves the right to terminate your participation in the Medicare Prescription Payment Plan if you fail to pay your bill more than 15 days past the due date.
● Your Part D drug coverage will not be impacted by the termination of participation in the Medicare Prescription Payment Plan.
● You can file a grievance or complaint with Troy Medicare by contacting Member Services at 1-888-494-TROY (8769) or TTY 711, via fax at 910-839-8320, mail, or contacting Medicare directly. Mail to: Troy Medicare, Attn: Appeals & Grievances, PO Box 1265, Westborough, MA 01581
You have the right to file a grievance or complaint with Troy Medicare by contacting Member Services at 1-888-494-TROY (8769) or TTY 711, via fax at 910-839-8320, mail, or contacting Medicare directly. Mail to: Troy Medicare, Attn: Appeals & Grievances, PO Box 1265, Westborough, MA 01581. Our agents are available Monday through Friday from 8am to 8pm EST during the months of April through September. During the months of October through March, we are available from 8:00 am to 8:00 pm, seven (7) days a week.
Where can I get more information?
● Visit Troymedicare.com or call 1-888-494-TROY (8769) to get more information.
● 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.
Online Election Form