800-958-1129 (TTY: 711)
We are open M-F 8:00 a.m. – 8:00 p.m. PT. Between 10/1 and 3/31, we are open 7 days a week, except for the major year-end holidays. You can enroll beginning 10/15/2025.
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Medicare Prescription Payment Program
WHAT IS THE MEDICARE PRESCRIPTION PAYMENT PLAN?
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). 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. All plans offer this payment option and participation is voluntary.
If you select this payment option, each month you’ll continue to pay Elite Health Plan premium (if you have one), and you’ll get a bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). There’s no cost to participate in the Medicare Prescription Payment Plan.
WHAT TO KNOW BEFORE PARTICIPATING
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 your health or drug plan.
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 take it home, call Elite Health Plan or ask the pharmacist.
This payment option might help you manage your monthly expenses, but it doesn’t save you money or lower your drug costs. Go to the section below on ”What programs can help lower my costs?” to learn about Extra Help and other programs that might save you money, if you qualify.
How is my monthly bill calculated?
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.
Please refer to the end of this material for examples of how your monthly bill is calculated.
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:
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The total amount you would have paid out of pocket to the pharmacy if you weren’t participating in this payment option.
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The Medicare drug coverage annual out-of-pocket maximum ($2,100 in 2026).
The prescription drug law caps your out-of-pocket drug costs at $2,100 in 2026. This is true for everyone with Medicare drug coverage, even if you don’t participate in the Medicare Prescription Payment Plan.
WILL THIS PROGRAM HELP ME OR AM I LIKELY TO BENEFIT FROM THE MEDICARE PRESCRIPTION PAYMENT PLAN?
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.
This payment option may not be the best choice for you if:
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Your yearly drug costs are low.
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Your drug costs are the same each month.
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You’re considering signing up for the payment option late in the calendar year (after September).
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You don’t want to change how you pay for your drugs.
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You get or are eligible for Extra Help from Medicare.
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You get or are eligible for a Medicare Savings Program.
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You get help paying for your drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP), a coupon program, or other health coverage.
WHO CAN HELP ME DECIDE IF I SHOULD PARTICIPATE?
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Elite Health Plan: Visit www.elitehealthplan.com/MPPP website, or call Elite Health Plan Customer Service at 1-888-807-5705 (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711 to get more information. If you need to pick up a prescription urgently, call Elite Health Plan Customer Service at 1-888-807-5705 (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711 to discuss your options.
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Medicare: Visit Medicare.gov/prescription-payment-plan to learn more about this payment option and if it might be a good fit for you.
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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.
HOW DO I SIGN UP?
Visit your Elite Health Plan MPPP website, or call us at Elite Health Plan Customer Service at 1-888-807-5705 (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711 to start participating in this payment option:
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In 2025, for 2026: If you want to participate in the Medicare Prescription Payment Plan for 2026, contact Elite Health Plan Customer Service at 1-888-807-5705 (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711. Your participation will start January 1, 2026.
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During 2026: Starting January 1, 2026, you can contact us at Elite Health Plan Customer Service at 1-888-807-5705 (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711 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.
WHAT TO KNOW IF I’M PARTICIPATING
What happens after I sign up?
Once Elite Health Plan reviews your participation request, we will send you a letter confirming your participation in the Medicare Prescription Payment Plan. Then:
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When you get a prescription for a drug covered by Part D, Elite Health Plan 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 take it home, call Elite Health Plan Customer Service at 1-888-807-5705 (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711 or ask the pharmacist.
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Each month, Elite Health Plan 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).
HOW DO I PAY MY BILL?
After Elite Health Plan approves your participation in the Medicare Prescription Payment Plan, you’ll get a letter from Elite Health Plan with information about how to pay your bill.
You may pay your bill via check or money order to:
Elite Health Plan
PO BOX 1439
Orange, CA 92856
WHAT HAPPENS IF I DON’T PAY MY BILL?
You’ll get a reminder from Elite Health Plan 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 Elite Health 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’re concerned about paying both your monthly plan premium and Medicare Prescription Payment Plan bills, go to the Section below on “What programs can help lower my costs?” for information about programs that can help lower your costs.
Call Elite Health Plan Customer Service at 1-888-807-5705 (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711 if you think Elite Health Plan made a mistake about your Medicare Prescription Payment Plan bill. If you think Elite Health Plan 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 Elite Health Plan Customer Service at 1-888-807-5705 (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711. Leaving won’t affect your Medicare drug coverage and other Medicare benefits. Keep in mind:
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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.
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You can choose to pay your balance all at once or be billed monthly.
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You’ll pay the pharmacy directly for new out-of-pocket drug costs after you leave the Medicare Prescription Payment Plan.
WHAT HAPPENS IF I CHANGE HEALTH OR DRUG PLANS?
If you leave Elite Health Plan, or change to a new Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage), your participation in the Medicare Prescription Payment Plan will end.
Contact your new plan if you’d like to participate in the Medicare Prescription Payment Plan again.
WHAT PROGRAMS CAN HELP LOWER MY COSTS?
If you have limited income and resources, find out if you’re eligible for one of these programs:
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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/ExtraHelp to learn more.
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Medicare Savings Programs: State-run programs that might help pay some or all of your Medicare premiums, deductibles, copayments, and coinsurance. Visit Medicare.gov/medicare-savings-programs to learn more.
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State Pharmaceutical Assistance Programs (SPAPs): Programs that might 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.
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Manufacturer Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs)): Programs 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 ssa.gov/locator/.
WHERE CAN I GET MORE INFORMATION?
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Elite Health Plan: Visit Elite Health Plan website (www.elitehealthplan.com/MPPP) or call your plan to get more information. Or you can call Elite Health Plan Customer Service at 1-888-807-5705 (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711.
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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.
The following materials are also available from CMS.
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English: https://www.medicare.gov/publications/12211-whats-the-medicare-prescription-payment-plan.pdf
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Spanish: https://www.medicare.gov/publications/12211-s-whats-the-medicare-prescription-payment-plan.pdf
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Chinese: https://www.medicare.gov/publications/12211-c-whats-the-medicare-prescription-payment-plan.pdf
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Korean: https://www.medicare.gov/publications/12211-k-whats-the-medicare-prescription-payment-plan.pdf
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Vietnamese: https://www.medicare.gov/publications/12211-v-whats-the-medicare-prescription-payment-plan.pdf.pdf
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English: https://www.medicare.gov/publications/12212-manage-your-monthly-drug-costs.pdf
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Spanish: https://www.medicare.gov/publications/12212-s-manage-your-monthly-drug-costs.pdf
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Chinese: https://www.medicare.gov/publications/12212-s-manage-your-monthly-drug-costs.pdf
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Korean: https://www.medicare.gov/publications/12212-k-manage-your-monthly-drug-costs.pdf
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Vietnamese: https://www.medicare.gov/publications/12212-v-manage-your-monthly-drug-costs.pdf
Additionally, CMS has released a public-facing webpage, available at https://www.medicare.gov/prescription-payment-plan , that includes information about the Medicare Prescription Payment Plan and an interactive wizard to help Part D enrollees determine if the payment option might help them.
Method
The Medicare Prescription Payment Plan –
Contact Information
Call
1-888-807-5705
Calls to this number are free. (Monday to Sunday 8:00 am – 8:00 pm). TTY users can call 711.
Member Services also has free language interpreter services available for non-English speakers.
TTY
711
This number requires special telephone equipment and is only for people who have difficulties with hearing or speaking.
Calls to this number are free. (Monday to Sunday 8:00 am – 8:00 pm).
FAX
1-800-958-1129
WRITE
Elite Health Plan
PO BOX 1439
Orange, CA 92856
WEBSITE
EXAMPLES OF HOW A MONTHLY BILL IS CALCULATED
Example 1:
You take several high-cost drugs that have a total out-of-pocket cost of $500 each month. In January 2026, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
Example 1: Start participating in January with high drug costs early in the year
Month
Your drug costs (without this payment option)
Your monthly payment (with this payment option)
Notes
February
$500
$75
April
$500
$180.56
This month you reached the annual out-of-pocket maximum ($2,100 in 2026). You’ll have no new out-of-pocket drug costs for the rest of the year.
May
June
July
August
September
October
November
December
$100
$0
$0
$0
$0
$0
$0
$0
$193.05*
$193.05*
$193.05*
$193.05*
$193.06*
$193.06*
$193.06*
$193.06*
*You’ll still get your $500 drugs each month, but because you’ve reached the annual out-of-pocket maximum in May with a partial payment, you won’t add any new out-of-pocket costs for the rest of the year. You’ll continue to pay what you already owe.
Total
$2,100.00
$2,100.00
You’ll pay the same total amount for the year, even if you don’t use this payment option.
If you’re concerned about paying $500 each month from January to partially in May, this payment option will help you manage your costs. If you prefer to pay $500 each month for 4 months, $100 for one month and then pay $0 for the rest of the year, this payment option might not be right for you. Contact your health or drug plan for personalized help.
EXAMPLES OF HOW A MONTHLY BILL IS CALCULATED
Example 2:
You take several drugs that have a total out-of-pocket cost of $80 each month. In January 2026, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
Month | Your drug costs (without this payment option) | Your monthly payment (with this payment option) |
|---|---|---|
January | $80.00 | $80.00 |
February | $80.00 | $7.27 |
March | $80.00 | $15.27 |
April | $80.00 | $24.16 |
May | $80.00 | $34.16 |
June | $80.00 | $45.59 |
July | $80.00 | $58.93 |
August | $80.00 | $74.92 |
September | $80.00 | $94.93 |
October | $80.00 | $121.59 |
November | $80.00 | $161.59 |
December | $80.00 | $241.59 |
Total | $960.00 | $960.00 |
Depending on your specific circumstances, you might not benefit from using this payment option due to the higher payments that start in September. Contact your health or drug plan for personalized help.
EXAMPLES OF HOW A MONTHLY BILL IS CALCULATED
Example 3:
You pay $4 every month in out-of-pocket costs for a prescription you use regularly.
In April 2026, you need a new one-time prescription that costs $613, so your total out-of-pocket costs in April are $617. That same month, before you fill your prescriptions, you decide to participate in the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.
We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
January
$500
$175
This is when you started participating in this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently.
March
$500
$125
Example 2: Start participating in January with consistent costs throughout the year
Example 3: Start participating in April with varying costs throughout the year
January | $4.00 | $4.00 | *You made these payments directly to the pharmacy before you started participating in the Medicare Prescription Payment Plan. |
February | $4.00 | $4.00 | |
March | $4.00 | $4.00 | |
April | $617.00 | $617.00 | This is when you started using this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently. |
May | $4.00 | $4.00 | |
June | $4.00 | $4.00 | |
July | $124.00 | $124.00 | This month, you need a drug that’s $120, in addition to your $4 drug. Following the same formula we used in May, your payments increase because you’re adding drug costs during the year, but you have fewer months left in the year to spread your payments across. |
August | $4.00 | $4.00 | |
September | $4.00 | $4.00 | |
October | $124.00 | $124.00 | This month, you need a drug that’s $120, in addition to your $4 drug. Following the same formula we used in May, your payments increase because you’re adding drug costs during the year, but you have fewer months left in the year to spread your payments across. |
November | $4.00 | $4.00 | |
December | $4.00 | $4.00 | |
Total | $889.00 | $889.00 | You’ll pay the same total amount for the year, even if you don’t use this payment option. |
If you’re concerned about paying $617 in April, this payment option will help you spread your costs across monthly payments that vary throughout the year. If you’re concerned about higher payments later in the year, this payment option might not be right for you. Contact your health or drug plan for personalized help.