Hurry to Sign Up for the 2026 Medicare Prescription Payment Plan

But people who have Part D can’t join on the spot when they learn about this at their pharmacies.

They must enroll online or by phone through their drug plan. The lack of pharmacy-counter sign-ups hurts program enrollment, Lin and Doshi say.

In 2024, the Centers for Medicare & Medicaid Services (CMS) said its research had determined no way to accommodate drugstore sign-ups without major technology upgrades because the computer systems don’t work together.

CMS suggested that Part D plans could allow their enrollees to join the installment program by having them step away from the pharmacy counter and call their Part D plan to sign up immediately or enroll online. Then they could ask their pharmacist to reprocess the prescription and pay nothing that day.

Valentine has doubts about how that scenario might play out. This year, he had to explain the program several times to unknowing drugstore pharmacists who, he says, incorrectly tried to bill him $38 and $600 up front for separate Part D–covered prescriptions this year — even though he was in the installment payment program. He had to make calls over several days to the pharmacy, his drug plan and its benefits management firm to resolve the problems.

“While it’s well intended, my experience with [the] Medicare prescription payment program is that there is a lack of communication on the front end to the pharmacists” by the drug plans and the entities that manage their prescription benefits, he says. “There’s not a complete understanding of how MPPP works.”

You’ll pay monthly, not at the pharmacy

Once in the payment plan, participants won’t be billed for medications when they’re picked up or delivered, because the Part D plan informs the pharmacy. Instead, enrollees get a statement each month directly from their prescription plan.

This is separate from any Part D plan premium bill if you have one. What you owe may change each month, especially if your doctor prescribes a new medication midway through the year, but the sum of your monthly bills will never exceed what you would have paid out-of-pocket by the end of the year if you weren’t participating in the program.

AARP has raised concerns with CMS about not allowing sign-ups at the pharmacy.

“We also understand that pharmacies are incredibly overwhelmed with the work they’re already doing, and so adding this to their plate is a big ask,” says Leigh Purvis, prescription drug policy principal with the AARP Public Policy Institute. AARP is encouraging CMS to “find solutions to help make it easier for people to enroll,” even if not at pharmacies.

In January 2025, AARP supported a CMS proposal to require that Medicare drug plans provide pharmacies with easy access to information about enrollees’ actual out-of-pocket costs under the Medicare Prescription Payment Plan. The agency didn’t finalize the proposal, citing public comments that pharmacies already receive this information when processing claims.

Current payment plan enrollment lower than projected

An estimated 68.1 million beneficiaries had Part D coverage in November 2025, but current enrollment for the installment payment plan is unknown.

About 6 percent of Part D enrollees were expected to benefit from the program, according to CMS. That would have worked out to be almost 4.1 million people in November 2025.

But as of July 2025, fewer than 1 percent, then about 330,000, were enrolled, researchers estimate. Those in the installment program last year were automatically reenrolled this year unless they changed Part D plans or asked their plans to exit the program.

Among those who could benefit most from the installment program are people not enrolled in Medicare’s Extra Help program, which subsidizes drug purchases for low-income beneficiaries. But of these beneficiaries who had filled a high-cost specialty drug prescription last year, an estimated 6.7 percent had signed up for the payment option in July 2025.

In December, Rep. Jennifer Kiggans (R-VA) introduced legislation, H.R. 6401, that directs the Department of Health and Human Services to provide Congress with a report that includes the number and geographic distribution of participants in the installment program. That report also would include an estimate of all who qualified for the payment program but did not enroll and steps CMS has taken to share information about joining the program when people first sign up for Medicare.

Many unaware of drug installment payment program

A clunky sign-up process, beneficiaries’ inability to enroll at the pharmacy counter and low public awareness have all contributed to the payment program’s slow start, Lin says.

“We just haven’t done a good enough job of letting people know about it,” he says. Patients, like shoppers, “love payment plans, but the problem is nobody even knows it exists.”

Overall awareness of the payment program increased to 25 percent of beneficiaries, up from just 8 percent in 2024, according to a 2025 online survey of 1,001 adult Medicare beneficiaries from the PAN Foundation. But 4 out of 10 who knew about the program say they didn’t understand it well.

Only 1 percent of those who take medications had enrolled, according to the survey. Nearly 3 in 4 said they were unlikely to do so.

A 2025 survey from the Partnership to Fight Chronic Disease of 500 older adults with Medicare drug coverage found 48 percent were unaware of the Medicare Prescription Payment Program, while about 1 in 4 knew either some or a lot about the program.

“I know lots of patients. I’m a member of multiple support groups and stuff, and a lot of people have no clue what MPPP is,” says Valentine, who retired in 2019 after more than 40 years in the technology industry.

Some uncertain of benefits after discovering program

Clyde Beverly, 71, of Birmingham, Alabama, had also never heard of the payment option. But after learning of it from AARP, Beverly discussed it with his drug plan and enrolled last week.

His costly medications, which include Ozempic, Jardiance and Entresto, were fully covered last year through his Medicare Advantage plan with drug coverage, he says. When that plan wasn’t offered in 2026, Beverly, a retired minister and hospice chaplain, chose new Medicare Advantage coverage that requires him to pay at least $72 a month for each of those three brand-name drugs and other medications.

“So I don’t have a choice but to be in the MPPP, because what was at no cost to me is now a cost,” Beverly says. He intends to call his drug plan and confirm his out-of-pocket costs with every prescription refill so he knows his expenses and can budget them.

“If I had never joined the MPPP,” Beverly says, his monthly drug costs in 2026 “would have been beyond what I could afford.”

Not every Part D enrollee benefits from the payment option, including those with low or manageable drug expenses and people who enroll later in the year with fewer months to spread out payments.

Medicare.gov has a tool that can help you determine whether the program is right for you and provides three examples of how a bill might look under three different circumstances.

What happens if I fall behind in my payments?

Beverly was worried that he could be pulled from the payment plan if he couldn’t fully pay his drug costs by the end of the year.

Those who fall at least two months behind in their payments can be disenrolled from the Medicare Prescription Payment Plan, the PAN Foundation says.

If removed, “you will still be enrolled in your Medicare Part D plan, and you still need to pay what you owe,” the foundation says. “Once you pay what is owed, you can rejoin the Medicare Prescription Payment Plan at any time by contacting your plan.”