This optional payment plan will help you manage your monthly expenses rather than paying your copayments or coinsurance at the pharmacy counter each time you fill a prescription. When you select this payment plan, Security Health Plan notifies your pharmacy to send your bills directly to us and we will then send you monthly invoices that you pay to Security Health Plan throughout the year.

Security Health Plan’s Medicare Part D members must opt into the payment plan and can opt out at any time.

• You’re most likely to benefit from this payment plan if you have high drug costs early in the calendar year. If you join the plan later in the year, you’ll have fewer months to spread out your drug costs, resulting in higher monthly payments.

The payment plan may not be the best choice for you if:

• You have low yearly drug costs
• Your drug costs are the same each month
• You get or are eligible for Extra Help from Medicare
• 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.

IMPORTANT: You can also get help to decide if the payment plan is right for you from the Medicare web page, "Will this payment option help me?"

How does Medicare's Extra Help work?

• If you have limited income and resources, you may be eligible for Medicare’s Extra Help program, also called Low Income Subsidy (LIS). The Extra Help program for those who qualify is more advantageous than participation in the Medicare Prescription Payment Plan.
• Extra Help is a Medicare program that helps pay your Medicare Part D prescription drug costs including premiums, deductibles and other costs. In 2024, the Extra Help program expanded to cover more drug costs for people with limited resources who earn less than 150% of the federal poverty level. In 2027, people who qualify for Extra Help generally will pay no more than $5.80 for each generic drug and $14.40 for each brand-name drug.
• Visit ssa.gov/medicare/part-d-extra-help to find out if you qualify and apply. You can also apply with your State Medical Assistance (Medicaid) office. Visit Medicare.gov/ExtraHelp to learn more.

What are the financial implications of opting into the payment plan?

• Starting early in the calendar year gives you more months to spread out your drug costs. Note that while this payment plan helps manage your monthly expenses, it does not lower your total drug costs for the year. However, you’ll never pay more than:
  • The total you would have paid to the pharmacy if you weren’t participating in this payment plan
  • The total annual out-of-pocket maximum for Part D drugs of $2,400 in 2027.

How are my monthly payments determined?

• Your monthly bill is based on what you would have paid the pharmacy for any prescriptions you get, plus your previous month’s balance, if any, divided by the number of months left in the year. Your payment may increase each month as you fill new or recurring prescriptions.

What happens if I don’t pay?

• If you are more than 60 days behind on paying your Medicare Prescription Payment Plan bills, you will be removed from the payment plan and will need to pay the pharmacy directly for your portion of new prescription drug costs. You may opt into the plan again only after you pay Security Health Plan the balance you owe. You will not be charged any interest or fees for the balance owed.

IMPORTANT: Always pay your Medicare Advantage plan premium first, if you have one, so you don’t lose your drug coverage. As long as you continue to pay the plan premium, you’ll still have drug coverage through your Medicare Advantage plan.

How do I opt into and out of the Medicare Prescription Payment Plan?

• You can opt in to the payment plan through the My Security Health Plan member portal. To opt in prior to that, please download, fill out and mail the Medicare Prescription Payment Plan Participation Request Form to Security Health Plan or call Customer Service.
• Once you have opted in, you can opt out anytime during the calendar year. If you opt out, however, you are required to pay Security Health Plan the entire balance remaining in your payment plan. You can choose to pay your balance all at once or be billed monthly.
• You will need to opt in again each calendar year that you wish to participate in the Medicare Prescription Payment Plan if you change your Medicare Part D plan. You can do this at the beginning of each year or anytime during that year. and we will immediately notify your pharmacy to send your prescription drug bills to Security Health Plan.
• You will not need to opt into the Medicare Prescription Payment Plan in the new year if you are already participating in the payment plan and remain in the same Part D plan.  You will be automatically renewed in the payment plan for the new year and will receive a notice before the start of the new year stating your participation in the payment plan and instructions on how to opt out if you want to.

What if I fill prescriptions before the payment plan is active?

• When you have certain urgent prescription fills for which you paid the associated cost sharing to the pharmacy before your Medicare Prescription Payment Plan election was received and processed, Security Health Plan will process a retroactive election if these two conditions are met:
  • You believe that any delay in filling the prescriptions due to the 24-hour timeframe required to process your request to opt into the Medicare Prescription Payment Plan may seriously jeopardize your life, health or ability to regain maximum function.
  • You request retroactive election into the Medicare Prescription Payment Plan within 72 hours of the date and time the urgent claims were adjudicated.
• Once your Medicare Prescription Payment Plan election is active, Security Health Plan will reimburse you within 45 calendar days of the election date for all costs paid for the urgent prescriptions and any other covered Part D prescriptions filled between the date the urgent claim was adjudicated and the date your election is effectuated.
• If Security Health Plan determines that you failed to request retroactive election within the required timeframe, we will promptly notify you of its determination and provide instructions on how you may file a grievance or complaint.

I’ve opted in; what can I expect now?

• When you opt into the Medicare Prescription Payment Plan, Security Health Plan notifies your pharmacy to send your bills directly to us. You will not pay the pharmacy directly for your prescription drugs. We will send you monthly invoices payable to Security Health Plan that spread out your prescription costs throughout the year.

What does the eligibility status mean?

• This status tells whether you have opted in, opted in pending approval, never opted in or opted out of the Medicare Prescription Payment Plan. If you would like to see your history of opting in and/or out of the payment plan, call Customer Service at (877) 998-0998 TTY 711.

Where can I find my billing and payment information for the plan?

• Once you are enrolled, you will find Medicare Prescription Payment Plan billing and payment information when you log into the My Security Health Plan member portal.

• You can file a grievance or complaint if you feel Security Health Plan failed to properly process your request to elect the Medicare Prescription Payment Plan. Here are the options:
  • Contact Security Health Plan Customer Service by phone at (877) 998-0998 TTY 711. If there is anything else you need to do, Customer Service will let you know.
  • If you do not wish to call (or you called and were not satisfied), put your grievance or complaint in writing and mail it to:

Security Health Plan
Attn: Pharmacy
P.O. Box 8000
Marshfield, WI 54449-8000

• Security Health Plan will look into your grievance or complaint and give you our answer within the deadlines required by the Centers for Medicare and Medicaid Services. For detailed information about grievances and complaints, see your Evidence of Coverage and find Chapter 9 titled “If you have a problem or complaint (coverage decisions, appeals, complaints).”

Security Health Plan and its agents are not in any way connected with the Medicare program. Security Health Plan of Wisconsin, Inc., is an HMO-POS and D-SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Security Health Plan depends on contract renewal.

Call Customer Service at (877) 998-0998 (TTY 711) for more information.

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Last updated October 1, 2026