Medicare Part D

Spreading Part D costs across the year: how University City residents can decide

University City, Mo. — If you take a costly prescription, you may have felt the sting of a single pharmacy bill that eats up a whole month's budget. Starting in 2025, Medicare gave Part D enrollees a new choice: instead of paying the pharmacy directly each time you pick up a drug, you can ask your Part D plan to bill you monthly for those out-of-pocket costs. It is called the Medicare Prescription Payment Plan, and it continues in 2027.

The program does not lower what you owe over the year. It spreads what you would have paid at the counter into monthly installments from your plan. Whether that helps depends on when your costs hit and how your cash flow looks month to month.

What the payment plan actually does

Under normal Part D billing, you pay your share (deductible, then copays or coinsurance) at the pharmacy each time you fill a prescription. Under the Medicare Prescription Payment Plan, the plan pays the pharmacy for your share, then sends you a monthly bill for what you owe. Your yearly total does not change — only the timing.

Every Part D plan and every Medicare Advantage plan that includes drug coverage must offer this option. That is true across the country, including in St. Louis County, where University City sits.

Who tends to benefit

This option is designed with a specific problem in mind: a big pharmacy bill early in the year. If you take an expensive brand-name drug, you might reach the deductible ($615 in 2026, $700 in 2027) in a single fill and face a large out-of-pocket charge in January or February. Spreading that same amount across the remaining months of the year can make it easier to plan.

People who often find the payment plan helpful include:

• Anyone who expects high out-of-pocket drug costs early in the year.
• People who would likely hit the annual out-of-pocket cap ($2,100 in 2026, $2,400 in 2027).
• Households on a fixed monthly income who want predictable pharmacy costs.

It is generally less useful if your drug costs are low and steady, or if you would rather pay small amounts at the pharmacy than receive a monthly bill.

How to opt in

You sign up through your Part D or Medicare Advantage drug plan — not through Medicare directly. You can:

• Call the member services number on your plan ID card and ask to enroll in the Medicare Prescription Payment Plan.
• Sign up on your plan's website or paper form.
• Ask before you fill a prescription if you think one is about to trigger a large bill; plans have to act on your request quickly.

You can join before the plan year begins or at any point during the year. If you join partway through the year, the amount already spent stays yours, but future out-of-pocket costs get spread across the months remaining.

How to opt out — and what happens if you miss a payment

You can leave the program at any time by telling your plan. If you opt out, you go back to paying the pharmacy directly at pickup.

If you do not pay your monthly bill from the plan, the plan can remove you from the payment program. You would still keep your Part D drug coverage as long as you keep paying your Part D premium, but you would owe the balance due and would go back to paying at the pharmacy.

A few things to weigh before opting in

• The bill still comes. This is not forgiveness; it is a schedule.
• Timing matters. Signing up in January generally spreads costs more smoothly than signing up in October.
• Low-Income Subsidy (Extra Help) already lowers what you pay. If you qualify for Extra Help, look at that first — it changes what you owe, not just when you owe it.
• Compare it to your own budget. Some people prefer to know a bill is coming monthly; others would rather pay per fill.

For a personal look at your situation, University City residents can contact Missouri's State Health Insurance Assistance Program (SHIP), known locally as CLAIM, for free one-on-one counseling.