Medicare Prescription Payment Plan Bill
The Medicare Prescription Payment Plan bills month by month.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Month of opting in, 1 to 12
- 3
- Part D out-of-pocket costs already paid this year
- 300 USD
- Out-of-pocket cost each month from opting in
- 200 USD
- Plan year
- 2026
Result: First bill $180.00 in March; $1,800.00 billed through December for $1,800.00 of costs (42 CFR 423.137(c)).
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Month of opting in, 1 to 12
- Part D out-of-pocket costs already paid this year
- Out-of-pocket cost each month from opting in
- Extra cost in the first month
- Plan year (blank for this year)
How this is calculated
Citation
42 CFR 423.137(c): the first month's cap is the out-of-pocket threshold less costs already incurred, over the months left; later months, the unbilled balance plus new costs over the months left. (e): likely to benefit at $600 for one drug. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.