Medicare Prescription Payment Plan

As a Network Health Medicare Advantage member with Part D prescription drug coverage, you are eligible to participate in the Medicare Prescription Payment Plan. This is a new program to help you manage your out-of-pocket Medicare Part D drug costs by spreading them out across the calendar year, which is defined as January through December.

The program is voluntary, so you must opt in if interested. After you opt in, the amount you pay at the pharmacy when you pick up your prescriptions is $0. Even though you won’t pay for your prescriptions at the pharmacy, you are still responsible for the cost. Each month you will receive a bill with the amount you owe for your prescriptions. This will be a separate bill from your plan premium.

This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs.

There is no cost to participate in the program. There are no fees or interest charges, even if your payment is late. View this Medicare Prescription Payment Plan fact sheet for more details.

How to Enroll

Medicare Part D members or their legal representatives must complete an election request form to opt in to the Medicare Prescription Payment Plan. The election enrollment form can be completed online at https://www.express-scripts.com/mppp. You can also opt in over the phone by calling 1-866-845-1803 (TTY 1-800-716-3231) 24 hours a day, seven days a week. If you would like to mail in a paper election form, complete the form available here and mail it to the address included on the form.

After your election enrollment request is received, we will send you a letter confirming your participation in the program. If you opt in during the annual enrollment period, prior to the upcoming plan year, you will receive the confirmation within 10 days of us receiving the request. If you opt in during the plan year, you will receive the confirmation within 24 hours of us receiving the request.

You can opt in during the annual enrollment period or any time during the plan year. It is important to note that if you opt in later in the plan year, the monthly payment amount will be higher because the payments are spread out over the months remaining during the plan year. It may not be beneficial for you to opt in later in the year. If you have questions on whether it will be beneficial for you to opt in, call us and we can go over that with you. We can be reached at 1-866-845-1803 (TTY 1-800-716-3231) 24 hours a day, seven days a week.

A calculator is available to help you determine if the Medicare Prescription Payment Plan would be beneficial for you. You will need to enter your estimated out-of-pocket Part D drug costs for each month into the calculator. Once your out-of-pocket costs are entered, you will be shown an estimated monthly payment schedule and some additional information to help you decide if the Medicare Prescription Payment plan is right for you.

If you change Medicare Part D plans during the plan year and you have opted in to the Medicare Prescription Payment Plan with the plan you are leaving, you will be required to opt in with your new Medicare Part D plan. Your opt in selection will not transfer from plan to plan. You will still be responsible for any outstanding Medicare Prescription Payment Plan balances with the plan you are leaving.

Frequently Asked Questions About the Medicare Prescription Payment Plan

If you believe that any delay in filling the prescription(s) due to the 24 hours timeframe required to process the request to opt in may seriously jeopardize your life, health, or ability to regain maximum function; and you requests retroactive election within 72 hours of the date and time the urgent prescriptions were filled, we can retroactively enroll you in the program effective the date of your request. You will need to pay for the out-of-pocket costs for those prescriptions at the pharmacy, and we will reimburse you for your costs. You will then receive a monthly bill for those prescription costs that will be spread out over the calendar year.

If you determine that the Medicare Prescription Payment Plan isn’t benefitting you after you’ve enrolled, you may opt out of the program at any time. You can opt out through the website at https://www.express-scripts.com/mppp or by calling 1-866-845-1803 (TTY 1-800-716-3231) 24 hours a day, seven days a week. If you opt out of the program but have already filled prescriptions at the pharmacy after opting-in, you will still be responsible for the monthly bill for those prescription costs. After you opt out, you’ll pay the pharmacy directly for new out-of-pocket prescription costs.

The program is available for all Network Health Medicare Advantage members with Part D prescription drug coverage, but it may not be beneficial for you to opt in. Generally, if you have a single prescription that costs $600 or more per fill or you will pay $2,000 out of pocket for your Part D prescription drugs during the plan year, you may benefit from this program. For the 2025 plan year, $2,000 is the most any member with Medicare Part D prescription drug coverage will pay out-of-pocket for Part D prescription drugs. If you have questions on whether it will be beneficial for you to opt in, call us and we can go over that with you. We can be reached at 1-866-845-1803 (TTY 1-800-716-3231) 24 hours a day, seven days a week.

This program may not be the best choice for you if the following apply.

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), like Wisconsin Senior Care, a coupon program, or other health coverage.

We will send you 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 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.

Always pay your health or drug plan monthly premium first (if you have one), so you don’t lose your drug coverage.

If you think there is a mistake with your bill, call us and we’ll go over your bill with you. We can be reached at 1-866-845-1803 (TTY 1-800-716-3231) 24 hours a day, seven days a week. If you want to file a grievance about a mistake with your bill, you can submit your grievance to us by calling 800-378-5234 (TTY 800-947-3529) Monday through Friday, 8 a.m. to 8 p.m. CST. Otherwise, you can submit your grievance in writing to the following address.

Network Health Medicare Advantage Plans
Attn: Appeals and Grievances
P.O. Box 120
1570 Midway Place
Menasha, WI 54942

If you have limited income and resources, find out if you’re eligible for one of these programs:

Extra Help: A Medicare program that helps pay your Medicare 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/basics/costs/help/medicaid to learn more.
Medicare Savings Programs: State-run programs that might help pay some or all
Wisconsin Senior Care: A program for older adults to help pay for prescription drugs and vaccines. Visit dhs.wisconsin.gov/seniorcare/index.htm to learn more.