Opting In & Out of the Medicare Prescription Payment Plan

How do I sign up for this payment option?

To sign up for this payment option, visit Activate.RxPayments.com or call 833-696-2087 (TTY 711). 

Timing of election requests received prior to the Plan year:

When an election request is received for the next, upcoming plan year (or in advance of a new plan enrollment effective date during a plan year), it will be processed within 10 calendar days of receipt, or the number of calendar days before the plan enrollment starts, whichever is shorter. If your request is received and it is determined that information is missing or invalid, we will reach out to you by phone or email within 10 days of the receipt of your request to complete the form. If the missing information is not provided within 21 calendar days, your request to participate will be denied. A written explanation along with our grievance process will be sent within 10 calendar days of that denial.

Timing of election requests received during the Plan year:

When an election request is received during the Plan year, we will communicate within 24 hours:

• An approval of the request and effective start data for the Medicare Prescription Payment Plan;
• A request for additional information; or
• A denial of the request through a written notice of denial.

Once your request to participate has been received, and it is not missing any information, you will receive approval/confirmation within 24 hours of receipt.

Conditions for Urgent Medicare Prescription Payment Plan Election:

During the plan year, if you need to pick up a prescription urgently and decide to pay the out-of-pocket cost at the pharmacy prior to your request to participate in the Medicare Prescription Payment plan being processed, we may be able to reimburse the cost but only if these conditions are met:

• You believe the 24-hour request to participate processing time and any delay in filling in prescription may seriously jeopardize your life, health or ability to regain maximum function; and 
• Your request to participate was made within 72 hours of the date and time of when you picked the prescription up at the pharmacy.

If it is determined that you failed to request program participation within the required timeframe, you will be promptly notified and provided instructions on how to file a grievance.

Can I opt-out of the Medicare Prescription Payment Plan?

You can leave the Medicare Prescription Payment Plan at any time by calling us at 833-696-2087 (TTY 711). Opting out of this payment option won’t affect your Medicare drug coverage and other Medicare benefits. Once your request to terminate participation is received, we will send confirmation of receipt within 10 calendar days.

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 the remaining amount 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.

If you leave your current 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 with your current plan will end. If you’d like to join the Medicare Prescription Payment Plan offered through your new plan, contact your new plan.