McLaren Medicare
Medicare Prescription Payment Plan

No, if you remain in the same McLaren Medicare plan, your participation in the Medicare Prescription Payment Plan will extend into the next plan year unless your opt out. If you change plans, you will have to opt in again.

It’s easy! Once you have enrolled in McLaren Medicare, go to the McLaren Medicare member portal to register: https://www.mclarenhealthplan.org/mclaren-health-plan/mclaren-connect. Log in and select Rx Claims to reach the MedImpact portal. Once you are in the MedImpact portal, click on “Medicare Prescription Payment Plan” at the top of the screen and then click “Opt In” on the Medicare Prescription Payment Plan page. You can pay online or by check or credit card.

You can opt-out in the same way, at any time. Once you opt-out, you will:

• Still need to pay any remaining balance on your account.
• Continue to receive bills until your balance is paid in full.
• Stop adding future costs to your balance.
• Pay the out-of-pocket costs for covered medications at retail, mail order and specialty pharmacies from that point forward.

Once you are enrolled, it’s important to be sure to make your payments timely each month. Failure to make your Medicare Prescription Payment Plan payment to McLaren Medicare each month could result in removal from the Medicare Prescription Payment Plan program, but not your coverage with McLaren Medicare.

You will get a monthly bill from McLaren Medicare instead of paying your copays at the pharmacy. Based on your start date in the program, your monthly payment could be as high as your total covered Part D drug costs for that month.

Your monthly bill is based on what you owe for any prescriptions you get, plus any balance from the previous month, divided by the number of months left in the year. Your payment can change every month as you fill new prescriptions or refill existing ones. These amounts will be added to your balance.

The good news is you won’t ever pay more than $2,000 for out-of-pocket costs for covered Part D drugs in 2025. This is true for everyone with Medicare drug coverage, even if you don’t join the program.

When you opt-in to the program, you will receive a monthly bill from McLaren Medicare for your pharmacy copays instead of paying them at the pharmacy. That bill is based on the out-of-pocket costs you normally would pay at the pharmacy, specialty pharmacy or by mail order.

As you get prescription services for Part D drugs, the dollars incurred will be added to your Medicare Prescription Payment Plan. You won’t make a copay at the pharmacy. 

Let’s walk through a sample scenario for January and February where you filled three regular prescriptions, then added a fourth prescription in February. 

Fill Date	Drug Cost	Copay	Pay at Pharmacy	Medicare Prescription Payment Plan Account Balance - Jan
1/2/2025	$500	$50	$0	$50
1/5/2025	$250	$25	$0	$75
1/10/2025	$750	$100	$0	$175

At the end of January, you have accumulated $175 in your Medicare Prescription Payment Plan account. This amount is divided by 12 equal payments for the rest of the year, making your monthly payment $14.58.

M3P Account Balance	Remaining Months	# Payments	Monthly Payment
$175	12	12	= $14.58

 

Fill Date	Drug Cost	Out of Pocket	Pay at Pharmacy	Medicare Prescription Payment Plan Account Balance - Feb
2/4/2025	$500	$50	$0	$50
2/5/2025	$250	$25	$0	$75
2/10/2025	$750	$100	$0	$175
2/15/2025	$400	$50	$0	$225

After February, you now have $225 from February, plus the balance from January of $160.42 ($175 - $14.58 payment = $160.42). Now, your new monthly payment is $35.04 calculated using the new balance of $385.42 ($160.42 + $225 = $385.42) divided by 11 remaining payments.

Running Balance	Remaining Months	# Payments	Monthly Payment
$385.42	11	11	= $35.04

In some cases, it may not make sense to use the Medicare Prescription Payment Plan. For instance, if you only get occasional prescriptions, it may be easier or more convenient to pay your copay at the pharmacy at the time you get your prescription. Or if it is late in the year and you incur a large out-of-pocket cost, you’ll only have a few months in which to spread the payment.

Enrollees who are most likely to benefit from this new Medicare Prescription Payment Plan include members who:

• spend more than $2,000 in covered out-of-pocket expenses in a plan year, or
• have a single prescription that costs $600 or more.

If there’s a chance you could benefit, consider opting in. You will be notified by letter if you are likely to benefit from this program. Signing up is free and is especially helpful for those with high out-of-pocket costs.

The Medicare Prescription Payment Plan might not be for you if you:

• already receive Extra Help or are Low-Income Subsidy (LIS)*
• are Dual Eligible or enrolled in a Special Needs Plan (D-SNP)
• receive assistance from a State Pharmaceutical Assistance Program (SPAP)
• receive assistance from a Patient Assistance Program (PAP).

*You can get additional information on LIS here including new information about the LIS expansion of eligibility.

If you don’t pay your past-due balance, here’s what you can expect:

• You will continue to receive bills until your past-due balance is paid.
• There is a 60-day grace period from your payment due date to your termination from the program.
• You will be ineligible to re-join the program until your past-due balance is paid. 
• Once your past-due balance is paid, you can rejoin the program anytime.

Note: This only applies to your participation in the Medicare Prescription Payment Plan. Your Medicare drug coverage and other Medicare benefits won’t be affected, and you’ll continue to be enrolled in your plan for your drug coverage.

Please call 844-336-2678 (TTY: 711) if you believe there has been a mistake and allow us to help. If you disagree with our decision, or if you disagree with any decision made by McLaren Medicare concerning your benefits or coverage, you have the right to have your information reviewed or file an appeal or a grievance. You can file an appeal here or file a grievance here. You must submit an appeal within 60 days after the incident or file a grievance within 60 days after the incident.

The Medicare Prescription Payment Plan provides eligible Medicare enrollees the opportunity to pay out-of-pocket prescription drug costs in monthly payments. This is an optional program.

If you opt-in to this new plan:

• You pay $0 out-of-pocket for covered medications when you visit the pharmacy.
• You spread your covered out-of-pocket costs over the remaining months in the year, depending on when you enroll.
• There is no interest charged for this service. It is free to use. You only pay the established out-of-pocket cost for your covered Part D medication spread out over monthly payments.
• You will be billed by McLaren Medicare, so you’ll always know where you stand.
• You can visit your member portal anytime to see the details of your bill.

By the end of the year, you’ll never pay more than:

• the total amount you would have paid out-of-pocket; or
• the out-of-pocket maximum for prescription drugs that are covered by your plan, which is $2,000 in 2025.

Here are some contacts that could help you decide if the program is right for you:

Medicare—Visit Medicare.gov, 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.

State Health Insurance Program (SHIP)—Visit shiphelp.org to get the phone number for your local SHIP and get free, personalized health insurance counseling.

McLaren Medicare—You can speak to a representative familiar with the Medicare Prescription Payment Plan 24 hours a day, seven days a week at 844-336-2678 (TTY: 711).

Medicare Prescription Payment Plan Fact Sheet – fact sheet from CMS.gov