Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan (sometimes referred to as the M3P or MPPP) is a payment option that will be available to anyone with a Medicare Advantage plan with drug coverage. The Medicare Prescription Payment Plan will allow you to manage your out-of-pocket Medicare Part D drug costs (prescription drug costs) by spreading them across the calendar year (January-December). If you select this payment option, you will continue to pay your premium (if you have one), and you’ll get a bill from Optum each month to pay for your prescription drugs (instead of paying at the pharmacy).
Quartz Medicare Advantage (HMO) and Quartz Dual Eligible have partnered with Optum for this prescription payment program. Optum is a pharmacy benefit manager that works with Quartz to administer pharmacy benefits.
To learn more and sign up for the Medicare Prescription Payment Plan, visit QuartzBenefits.com/M3PEnroll. This link opens an Optum website in a new browser window. You can also download a printable Medicare Prescription Plan application (Terms and Conditions). Complete, sign, and mail it to us at the address on the application.
Overview
- Participation is voluntary and there is no cost to participate in the Medicare Prescription Payment Plan.
- You won’t pay any interest or fees on the amount you owe, even if your payment is late.
- Pay nothing at the pharmacy counter. After you enroll in the Medicare Prescription Payment Plan, you can pick up your prescriptions at the pharmacy and owe $0 to the pharmacy. You will instead be responsible for paying a monthly bill for the prescriptions you fill.
- Spread your cost over the rest of the plan year. Pay for your prescriptions in monthly installments over the remaining months of the year after you enroll.
- Your prescription costs are capped after you reach your yearly $2,100 out-of-pocket maximum.
- Once you reach the out-of-pocket maximum for the plan year, additional prescription drug costs will not be added to your Medicare Prescription Payment Plan program balance.
- You will continue to pay your monthly billed amount for the rest of the plan year, or you can pay the balance in a lump sum.
- You can end your participation in the Medicare Prescription Payment Plan anytime. However, you will be responsible to pay your Medicare Prescription Payment Plan balance owed in monthly payments or in a lump sum payment even if you stop participating in the program.
- If you stop participation in the Medicare Prescription Payment Plan, you will return to paying for your prescriptions at the pharmacy.
- Call Optum Customer Service at (844) 368-8729 to enroll or for additional information or questions related to the Medicare Prescription Payment Plan. You may also call the phone number on the back of your ID card.
How does it work?
After you enroll in the Medicare Prescription Payment Plan, when you fill a prescription for a drug covered by Part D, you won’t pay at the pharmacy (including mail-order and specialty pharmacies). Instead, you’ll get a bill each month from Optum.
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 will not reduce the amount of cost-sharing you owe for your Part D prescriptions. Whether you participate in the Medicare Prescription Payment Plan or not, you will never pay more than $2,100 in a plan year for your covered Part D medications.
Will the Medicare Prescription Payment Plan 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 are 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, gives you more months to spread out your drug costs.
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 sign up for the Medicare Prescription Payment Plan late in the calendar year (after September).
- You get or are eligible for Extra Help from Medicare or 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.
- Visit Medicare.gov – Will this help me to learn more about how this payment option can help you (by clicking on this link, you will leave the Quartz Medicare Advantage website).
- Visit Medicare.gov – Prescription Payment plan to learn more about the Medicare Prescription Payment Plan (by clicking on this link, you will leave the Quartz Medicare Advantage website).
Who can help me decide if I should participate?
- For answers to your questions, you can call Optum Customer Service at (844) 368-8729 (TTY: 711) for answers to your questions.
- Medicare: Visit medicare.gov to learn more about this payment option and if it might be a good fit for you (by clicking on this link, you will leave the Quartz Medicare Advantage website).
- 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 (by clicking on this link, you will leave the Quartz Medicare Advantage website).
What to know if I’m participating
- Call Optum Customer Service (844) 368-8729 (TTY: 711), 5 a.m. – 10 p.m., 7 days a week. For additional information or questions related to the Medicare Prescription Payment Plan.
- Medicare: Visit Medicare.gov, 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 (by clicking on this link, you will leave the Quartz Medicare Advantage website).
What happens after I sign up?
Optum will review your participation request and will process the request within 10 days. You may collect prescription(s) and pay your original cost share at the pharmacy while the review is pending.
After review, Optum will call you on behalf of Quartz and send you a letter confirming your participation in the Medicare Prescription Payment Plan. You will not receive a call if you are on the Do Not Call list.
If you have an urgent need to fill your prescription(s) without waiting for your request to process (i.e., waiting may seriously jeopardize your life, health, or ability to regain maximum function), you may fill the prescriptions and pay at the pharmacy, then contact us within 72 hours to have the claims reprocessed under the Medicare Prescription Payment Plan.
Then:
- When you get a prescription for a drug covered by your Quartz Medicare Advantage prescription coverage, you won’t pay the pharmacy for the prescription. However, you’re still responsible for the costs. If you want to know what your drug will cost before you take it home, call Optum Customer Service (844) 368-8729 (TTY: 711) or ask your pharmacist.
- Each month, Optum will send you a bill for your prescriptions and information on how to make a payment. You’ll get a separate bill for your monthly plan premium (if you have one).
What happens if I don’t pay my bill?
You’ll get a reminder from Optum if you miss a payment. If you don’t pay your bill by the date noted in that notice, 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. Call Optum Customer Service (844) 368-8729 (TTY: 711) if you think there is a mistake on your Medicare Prescription Payment Plan bill.
Always pay your Quartz Medicare Advantage or Dual Eligible plan monthly premium first (if you have one), so you don’t lose your drug coverage. If you’re concerned about paying both your monthly plan premium and Medicare Prescription Payment Plan bills, go to the section below titled “What programs can help lower my costs?” to learn about programs that can help lower your costs.
How is my monthly bill calculated?
When you are billed monthly, the bill will be 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 calculate the monthly payments in the same way.
Your payments may change every month, so you might not know what your exact bill will be ahead of time.
Future payments may increase as you fill prescriptions 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, 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 the Medicare Prescription Payment Plan.
- The Medicare drug coverage annual out-of-pocket maximum ($2,100).
Can I leave the program?
You can leave the Medicare Prescription Payment Plan at any time by calling Optum Customer Service at (844) 368-8729 (TTY: 711). Leaving won’t affect your Medicare drug coverage or 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 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?
If you have limited income and resources, you may be eligible for one of these programs:
- Extra Help: A Medicare program that helps pay your Medicare drug costs. Provides assistance in affording Medicare prescription drug coverage premiums and out-of-pocket drug costs to certain individuals with limited resources and who earn up to 150% of the federal poverty level. If you qualify, this is likely to be more advantageous to you than participation in the Medicare Prescription Payment Plan. Visit Medicare.gov – Extra help to find out if you qualify and apply. You can also apply with your State Medical Assistance (Medicaid) office. Visit Medicare.gov – Help with drug costs to learn more (by clicking on this link, you will leave the Quartz Medicare Advantage website).
- Medicare Savings Programs: State-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance. Visit Medicare.gov – Savings programs to learn more (by clicking on this link, you will leave the Quartz Medicare Advantage website).
- Manufacturer Pharmaceutical Assistance Programs or Patient Assistance Programs (PAPs): Programs from drug manufacturers to help lower drugs costs for people with Medicare. Visit Medicare.gov – PAP help to learn more (by clicking on this link, you will leave the Quartz Medicare Advantage website).
Many people qualify for savings and don’t realize it. Find your local Social Security office at SSA.gov – Office locator (by clicking on these links, you will leave the Quartz Medicare Advantage website).
Where can I get more information?
- You can call Optum Customer Service (844) 368-8729 for additional information or questions related to the Medicare Prescription Payment Plan (M3P).
- Medicare: Visit medicare.gov, 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 (by clicking on this link, you will leave the Quartz Medicare Advantage website).
How do file a Medicare Prescription Payment Plan complaint or grievance?
You have the right to file a complaint or grievance regarding the Medicare Prescription Payment Program. Please contact us by telephone at (800) 394-5566 (TTY: 711). We are available to assist you, Monday through Friday from 8 a.m. to 8 p.m. In addition, from October 1 through March 31 we are available seven days a week from 8 a.m. to 8 p.m. For more information about complaints and grievances, please review your Evidence of Coverage (EOC) document. You can view your EOC by logging in to your Quartz MyChart (by clicking on this link, you will leave the Quartz Medicare Advantage website).