Medicare Prescription Payment Program (MPPP)

The Medicare Prescription Payment Plan (MPPP), created by the Inflation Reduction Act of 2022 is a new way to pay for your Medicare Part D prescription drugs. Starting in 2025, you can choose to make monthly payments rather than paying all your out-of-pocket costs at once.

Here’s what you need to know:

• It’s a way to pay for your medicines – instead of paying the full cost at the pharmacy, you spread out your drug costs.
• You make monthly payments – your out-of-pocket costs are divided across the whole calendar year (January–December).
• It works with your Medicare drug coverage – for your Medicare Part D prescription drugs. It doesn’t apply to Part B drugs or drugs your plan doesn’t cover.
• All Medicare drug plans offer it – every plan must give you this option.
• It doesn’t cost anything extra – there are no fees to join.
• It’s your choice – participation is voluntary.

You can learn more about this program by reading the Prescription Payment Plan Fact Sheet from the Centers for Medicare & Medicaid Services (CMS).

Extra Help

• The Extra Help program helps pay for your Medicare prescription drug plan costs.
• Apply online at https://ssa.gov/medicare/part-d-extra-help or through your state medical assistance (Medicaid) office.
• Learn more at https://medicare.gov/ExtraHelp.

Medicare Savings Programs

• These programs are run by your state and may help pay Medicare Part A and Part B costs (like premiums, deductibles, and coinsurance).
• Learn more at https://medicare.gov/medicare-savings-programs.

State Pharmaceutical Assistance Programs (SPAPs)

• Some states offer programs that help with Medicare drug plan premiums or costs.
• Payments from these programs may count toward your yearly Medicare drug plan out-of-pocket limit ($2,100 in 2026).
• Learn more at https://go.medicare.gov/spap.

Manufacturer Pharmaceutical Assistance Programs or  Patient Assistance Programs (PAPs):

• Drug manufacturers may offer programs to help lower drug costs for people with Medicare.
• These programs do not usually count toward your Medicare Part D out-of-pocket limit.
• Learn more at https://go.medicare.gov/pap.

Many people qualify for savings and don’t know it. To learn more:

• Visit https://www.medicare.gov/basics/costs/help
• Contact your local Social Security office.
• You can find your local Social Security office at https://ssa.gov/locator/

Important Things to Know

• Changing plans mid‑year: If you change Part D plans during the year, you’ll need to opt in again with your new plan. Any balance you already owe stays with your prior plan and must still be paid.
• Leaving the program: You can opt out at any time. We’ll keep billing any remaining balance monthly (we won’t require a lump sum). After you opt out, you’ll pay new pharmacy costs at the counter again.

Helpful if You:

• Have high drug costs early in the year (for example, a new expensive prescription in January through March).
• Take multiple medicines with higher copays/coinsurance.
• Prefer a steady monthly bill instead of paying larger amounts at the pharmacy.

May Not Benefit if You

• If you get Extra Help (LIS) or are eligible for Extra Help (LIS), this payment option will likely not lower your costs and may not be the best choice for you. We can help you confirm your status and apply for Extra Help (LIS) if you qualify.
• Have low or stable drug costs during the year.
• Only expect one high‑cost fill late in the year.

Most D‑SNP members either already have Extra Help or are likely to qualify. Use our decision guide below and talk to us if you’re unsure.

Quick Decision Guide

• Do you have or qualify for Extra Help (LIS)? If yes, Extra Help generally reduces your costs more than this program. Apply or verify first. If you still want to spread costs into monthly bills, you can opt in to the Payment Plan anytime.
• High drug costs early in the year? The program can make payments more predictable.
• Low or occasional drug costs? You may not benefit from the program.

What to Know Before Participating

When you fill a prescription for a drug covered by Part D, you will not  pay your pharmacy (including mail-order and specialty pharmacies). Instead, you’ll get a bill each month from your health plan, CenCal CareConnect.

• $0 at the pharmacy: When you opt in, you won’t pay at the counter for covered Part D drugs you fill while in the program. We pay the pharmacy.
• Monthly bill from us: We total the Part D costs you’d otherwise have paid and bill you monthly. Your first month and later months may be different.
• Your monthly amount can change: If you add or stop medicines, your bill may go up or down. If you reach the annual out‑of‑pocket (OOP) threshold for Part D ($2,100 in 2026), you won’t owe anything new for the rest of the year, and your remaining balance will be spread over the months left in the year.
• End‑of‑Year: Any remaining balance for drugs you got while participating must still be paid by December 31.

Costs & Billing

• Free to join: There are no program fees, late fees, or interest.
• Monthly bills: We will send a bill each month with what you owe. You can pay online, by phone, or by mail.
• Accessible formats: No matter how you choose to get or return forms (online, phone, or mail), we can provide everything in the format that works best for you—such as large print, braille, audio, or another language—at no cost.
• Staying current matters: If you miss a payment:
  • We’ll send you a first notice within 15 days of the missed due date.
  • You’ll then have a two-month grace period to catch up.
  • If the full overdue amount is still not paid by the end of the grace period, we’ll send you a final termination notice within three calendar days. Your participation will end, and you’ll go back to paying at the pharmacy for new prescriptions.
• If you fall behind because of life events: You may ask to rejoin the program if you had a good reason (for example, illness or hardship) and you pay what you owe. We’ll review your request and let you know if we can reinstate your participation.

How Your Monthly Bill is Calculated

Your monthly bill is based on:

1. Your prescription drug costs – what you would have paid at the pharmacy.
2. Any balance from last month – what you still owe.
3. The number of months left in the calendar year (January–December).

We add your prescription costs and any unpaid balance together, then divide that total by the number of months left in the year. This helps spread out your costs into smaller, predictable monthly payments.

Why Your Payments May Change

• New prescriptions or refills: If you add new drugs during the year, your costs go up. Since there are fewer months left to spread them over, your monthly bill may increase.
• Stopping medicines: If you stop a drug, your bill may go down.
• No changes: If nothing changes, your monthly bill may stay the same.

Limits on What Your Pay

You’ll never pay more than:

• The total amount you would have paid at the pharmacy without this payment plan, or
• The Medicare annual out-of-pocket maximum for drug costs.

For 2026, the law caps your out-of-pocket drug costs at $2,100 for the year. Once you reach that limit, you will not owe anything new for the rest of the year. This cap applies to everyone with Medicare drug coverage, whether or not you join the Medicare Prescription Payment Plan.

Example Scenarios

Tip: If you join late in the year, your monthly bill can be higher because costs are spread over fewer months.

1. Early-Year High-Cost Example
   • In January, your drug costs are $1,200.
   • Spread over 12 months, your monthly bill is about $100 each month.

2. Late-Year High-Cost Example
   • In November, you start a new medicine that costs $500.
   • Spread over only two months (November–December), your bill is about $250 each month.

3. Reaching the Annual Cap
   • By August, you reach the $2,100 cap.
   • You won’t owe anything new for the rest of the year.
   • If you had a balance left in August, we’ll spread that across September–December.

4. Members with Full Extra Help (LIS + Medi-Cal)
   • You already pay $0 at the pharmacy.
   • Your monthly bill is $0. Joining this plan isn’t needed.

5. If You Gain Extra Help Mid-Year
   • Suppose your bill was $75 per month.
   • Once Extra Help starts, we recalculate using the CMS formula, and most people owe $0 going forward.

Who Can Help Me Decide if I Should Participate?

• CenCal CareConnect Pharmacy Customer Service: Call 1-833-726-0676 (TTY: 711). We can also help you check Extra Help eligibility.
• Medicare: Visit https://medicare.gov/prescription-payment-plan to learn more about this payment option and if it might be a good fit for you.
• State Health Insurance Assistance Program (SHIP): Visit https://shiphelp.org/ to get the phone number for your local SHIP and get free, personalized health insurance counseling.

When Your Participation Starts

• During the plan year: We process requests within 24 hours. You’ll get a phone call and a written notice confirming your start date.
• Before the plan year begins (or before a new enrollment effective date): We process requests within 10 calendar days and send you a written confirmation. Confirmation notices are available in accessible formats upon request, at no cost.
• Urgent situations (retroactive election): If you had to fill an urgent prescription before we could process your request, you may ask us to make your participation retroactive so we can include that cost on your bill and reimburse you. You must request this within 72 hours of the urgent fill. We will reimburse appropriate costs and include them in your bill within 45 days of your election date.

How to Opt Out (Leave the Program)

You can leave the Medicare Prescription Payment Plan at any time. To opt out, contact us online, by phone, or by mail, whichever is easiest for you.

When we get your request:

• We will send you a Notice of Voluntary Removal from the Medicare Prescription Payment Plan within 10 calendar days to confirm you have left the program.
• You will still get monthly bills for any balance you already owe, but you will go back to paying your share of drug costs directly at the pharmacy for new prescriptions.

If You Are Mistakenly Disenrolled

If you are ever mistakenly disenrolled from your Part D plan and then reinstated, we will also reinstate your participation in the Medicare Prescription Payment Plan. This means:

• Your participation will be restored back to the original date when you should have remained in the program.
• We will reimburse you for any out-of-pocket drug costs you paid while your participation was incorrectly stopped.
• Any costs that apply will be included in your regular monthly bill.
• You will get a written notice confirming your reinstatement.

Frequently Asked Questions

Questions & Help

Pharmacy Help Desk & Customer Service 24/7: Call the number on your CenCal CareConnect member ID card: 1-833-726-0676 (TTY: 711). We’re happy to explain how the program works and help you decide if it’s right for you.

Extra Help (LIS): Many D‑SNP members get Extra Help automatically (for example, with Medi‑Cal, a Medicare Savings Program, or SSI). If you don’t already have Extra Help, we’ll help you check eligibility and apply. Visit https://www.ssa.gov/medicare/part-d-extra-help or call 1‑800‑772‑1213 (TTY 1‑800‑325‑0778). Your State Health Insurance Assistance Program (SHIP) can also help for free.

Medicare information: Visit https://www.medicare.gov/ and search for “Prescription Payment Plan.”

File a Complaint or Ask for an Appeal

If you have a complaint about this program (for example, a billing dispute), you can file a grievance. To request a coverage decision or appeal, visit our Grievances & Appeals page or call Member Services at 1-877-814-1861 or TTY: CA Relay at 711 (for members who are deaf, hard of hearing, or have a speech disability). We follow Medicare’s standard and expedited timeframes.

Accessibility & Language Supports

This page meets accessibility requirements. We can provide materials in large print, braille, audio, or other formats at no cost.

We provide free language assistance. Call Member Services at 1-877-814-1861 or TTY: CA Relay at 711 (for members who are deaf, hard of hearing, or have a speech disability).

We do not discriminate based on race, color, national origin, disability, age, or sex.

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