No. The payment option only applies to prescription Part D drugs. Drugs covered by Medicare Part A, Part B, and excluded Part D drugs are not eligible to be included.

Your monthly bill is based on what you would have paid for any prescriptions you get, plus your previous month’s balance, divided by the number of months left in the year.

Your payments might change every month, so you might not know what your exact bill will be ahead of time. Future payments might increase when you fill a new prescription (or refill an existing prescription) because as new out-of-pocket costs get added to your monthly payment, there are fewer months left in the year to spread out your remaining payments.

In a single calendar year (January – December), you’ll never pay more than:

• The total amount you would have paid out of pocket to the pharmacy if you weren’t participating in this payment option.
• The Medicare drug coverage annual out-of-pocket maximum ($2,100 in 2026).

  The prescription drug law caps your out-of-pocket drug costs at $2,100 in 2026. This is true for everyone with Medicare drug coverage, even if you don’t participate in the Medicare Prescription Payment Plan.

  All plans use the same formula to calculate your monthly payments. Here is an example of what your monthly bills could look like in 2026.

  Start participating in January with consistent costs throughout the year

  You take several drugs that have a total out-of-pocket cost of $80 each month. In January 2026, you join the Medicare Prescription Payment Plan through your Medicare drug plan or Medicare health plan with drug coverage.

   

  Month	Your monthly drug costs (without this payment option)	Your monthly payment (with this payment option)	备注
  一月	$80	$80	This is when you started participating in this payment option. Remember, your first month’s bill is based on the “maximum possible payment” calculation. We calculate your bill for the rest of the months in the year differently.
  二月	$80	$7.27
  三月	$80	$15.27
  四月	$80	$24.16
  五月	$80	$34.16
  六月	$80	$45.59
  七月	$80	$58.93
  八月	$80	$74.92
  九月	$80	$94.93
  十月	$80	$121.59
  十一月	$80	$161.59
  十二月	$80	$241.53
  Total	$960	$960	You’ll pay the same total amount for the year, even if you don’t use this payment option.

   

  Depending on your specific circumstances, you may not benefit from using this payment option due to the higher payments later in the year. Contact your health or drug plan for personalized help.

  We calculate your first month’s bill in the Medicare Prescription Payment Plan differently than your bill for the rest of the months in the year:
• First, we figure out your “maximum possible payment” for the first month:

$2,100 (annual out-of-pocket maximum)– $0 (no out-of-pocket costs before using this payment option) = $2,100 12 (remaining months in the year)

= $175 (your “maximum possible payment” for the first month)

• Then, we figure out what you’ll pay for January:
• Compare your total out-of-pocket costs for January ($80) to the “maximum possible payment” we just calculated: $175.
• Your plan will bill you the lesser of the two amounts. So, you’ll pay $80 for the month of January.
• You have a remaining balance of $0.

For February and the rest of the months left in the year, we calculate your payment differently:

$0 (remaining balance) + $80 (new costs) = $80 11 (remaining months in the year)

= $7.27 (your payment for February)

We’ll calculate your March payment like we did for February:

$72.73 (remaining balance) + $80 (new costs) = $152.73 10 (remaining months in the year)

= $15.27 (your payment for March)

Even though your payment varies each month, you’ll never pay more than:

• The total amount you would have paid out-of-pocket by the end of the year.
• The out-of-pocket maximum for prescription drugs that are covered by your plan ($2,100 in 2026).

Remember, this is just your monthly payment for your out-of-pocket drug costs. You still need to pay your health or drug plan’s premium each month.

Anyone with a Medicare health plan with drug coverage can use this payment option but remember it does not lower your drug cost or save you money. Because all CareOregon Advantage members receive Extra Help, you will likely not benefit from this payment option because you already have low and consistent drug costs, and you receive help paying your drug costs.

The program may NOT be a good fit for you if:

• You get or are eligible for Extra Help from Medicare.
• Your yearly drug costs are low.
• Your drug costs are the same each month.
• You’re considering signing up for the payment option late in the calendar year (after September).
• You don’t want to change how you pay for your drugs.
• You get or are eligible for a Medicare Savings Program.
• You get help paying for your drugs from other organizations, like a State Pharmaceutical Assistance Program (SPAP), a coupon program, or other health coverage.

You can go to Medicare.gov/prescription-payment-plan/will-this-help-me to answer a few questions, and find out if you’re likely to benefit from this payment option.

All CareOregon Advantage members are eligible for a Medicare program called Extra Help. This program helps you pay for your Medicare Part D drug costs.

If you have limited income and resources, find out if you’re also eligible for one of these other programs:

• State Pharmaceutical Assistance Programs (SPAPs): Programs that might include coverage for your Medicare drug plan premiums and/or cost sharing. SPAP contributions may count toward your Medicare drug coverage out-of-pocket limit. Visit go.medicare.gov/spap to learn more.
• Manufacturer Pharmaceutical Assistance Programs (sometimes called Patient Assistance Programs (PAPs)): Programs from drug manufacturers to help lower drugs costs for people with Medicare. Visit go.medicare.gov/pap to learn more.

Many people qualify for savings and don’t realize it. Visit Medicare.gov/basics/costs/help, or contact your local Social Security office to learn more. Find your local Social Security office at ssa.gov/locator/

OptumRx: Call 844-368-8729

Medicare: Visit 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): Call your local SHIP at 800-722-4134 and get free, personalized health insurance counseling.

OptumRx is working with CareOregon Advantage to help with the Medicare Prescription Payment Plan. Call OptumRx with questions or, if you’re ready to sign up, you can do so online or by mail.

Online: https://m3p-form.benefitrx.com/?cid=careorgn 

电话： 844-368-8729

Mail: Fill out the Medicare Prescription Payment Plan participation request form and mail it to the address listed on the form

If you sign up in 2025, your participation will start January 1, 2026. After January 1, you can contact us to participate in the program anytime during the calendar year. Remember, this payment option may not be the best choice for you if you sign up late in the 2026 (after September). This is because as new out-of-pocket drug costs are added to your monthly payment, there are fewer months left in the year to spread out your payments.

Once OptumRx reviews your participation request, they’ll send you a letter confirming your participation in the Medicare Prescription Payment Plan. Then:

1. When you get a prescription for a drug covered by Part D, OptumRx will automatically let the pharmacy know that you’re participating in this payment option, and you won’t pay the pharmacy for the prescription. Even though you won’t pay for your drugs at the pharmacy, you’re still responsible for the costs. If you want to know what your drug will cost before you take it home, call OptumRx or ask the pharmacist.
2. Each month, OptumRx will send you a bill with the amount you owe for your prescriptions, when it’s due, and information on how to make a payment.

If you paid for a prescription drug at the pharmacy and could not wait for the election to be processed, you may qualify for retroactive election and reimbursement if you meet all of the following conditions.

1. You believe that any delay in filling the prescription, due to the 24 hour timeframe required to process your request to opt into the program, may seriously jeopardize your life, health or ability to regain maximum function; and
2. You request the retroactive election with 72 hours of the date and time the urgent prescription claim was billed to us.

After OptumRx approves your participation in the Medicare Prescription Payment Plan, you’ll get a letter from your plan with information about how to pay your bill.

You’ll get a reminder from OptumRx if you miss a payment. If you don’t pay your bill by the date listed in that reminder, you’ll be removed from the Medicare Prescription Payment Plan. You’re required to pay the amount you owe, but you won’t pay any interest or fees, even if your payment is late. You can choose to pay that amount all at once or be billed monthly. If you’re removed from the Medicare Prescription Payment Plan, you’ll still be enrolled CareOregon Advantage.

If you think we made a mistake about your Medicare Prescription Payment Plan bill, call OptumRx. You also have the right to follow the grievance process described below to file a complaint.

You can leave the Medicare Prescription Payment Plan at any time by contacting OptumRx. Leaving won’t affect your Medicare drug coverage and other Medicare benefits. 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 your balance 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 CareOregon Advantage, 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 will end. Contact your new plan if you’d like to participate in the Medicare Prescription Payment Plan again.

If you have a problem with your prescription drug coverage including the Medicare Prescription Payment Plan, you can file a complaint or grievance.

To contact us by telephone, call Customer Service at 503-416-4279, toll-free 888-712-3258 or TTY 711. Our hours are 8 a.m. to 8 p.m. seven days a week, October 1 to March 31, and 8 a.m. to 8 p.m. Monday through Friday, April 1 to September 30. Our fax number is 503-416-8118.

如需通过邮寄方式投诉，我们的地址为：

CareOregon Advantage
315 SW Fifth Ave
Portland, OR  97204