The Centers for Medicare and Medicaid Services (CMS) provides the following guidance explaining how Medicare beneficiaries can receive a refund or repayment of their overpaid copayments and premiums from their Medicare Part D drug plan or Medicare Advantage plan.
How to get reimbursed from a Medicare plan
Question: What should people with Medicare do if they paid out-of-pocket for
drug costs because they needed to fill a prescription before they got
their plan membership card or confirmation letter?
A Medicare drug plan will reimburse people with Medicare who pay for
prescriptions that should be covered by their plan. To get reimbursed,
the person should take the following steps:
- Save the original receipt from the drug purchase. If the person
no longer has the original receipt, he or she can contact the pharmacy
and ask for a replacement receipt or other proof of purchase.
- Call the plan's customer service number on the membership card,
read the plan's printed materials, or look on the plan's member website
to find out about the reimbursement process.
- Get a copy of the plan's claim submission or reimbursement form, if needed.
- Fill out the form and submit it to the plan with the original or replacement receipt.
You can also check your Medicare plan's Evidence of Coverage for more information on getting reimbursed for out-of-pocket costs.
Question: What if someone who qualifies for the low-income subsidy (LIS),
but doesn't have proof is charged an incorrect deductible or copayment
To avoid paying incorrect amounts, people who qualify for
LIS should provide the pharmacy with the following documents as proof
- A copy of their yellow, green, or purple automatic enrollment letter from Medicare
- Their "Notice of Award" from Social Security
- Their Medicaid card (if they have one) or any document that shows they have Medicaid
- A bill from an institution (like a nursing home) or a copy of a
state document showing Medicaid payment to the institution for at least
- A screen print from their state's Medicaid systems showing that they lived in the institution for at least a month
If proof isn't available, a person who qualifies for LIS should
contact their State Medical Assistance (Medicaid) office or Social
Security to get at least one of the documents mentioned here. The person
can call 1-800-MEDICARE (1-800-633-4227) to get the telephone number
for their Medicaid office. TTY users should call 1-877-486-2048.
who qualify for the LIS who aren't charged the correct deductible or
copayment amount should contact their Medicare drug plan to find out how
to submit a claim for reimbursement. They should save the original
receipt from the purchase in case they need to submit it with the claim.
The Medicare drug plan will refund any amount that is due.
Question: How will pharmacies be reimbursed for payments they made on behalf
of people with Medicare and Medicaid who live in long-term care
facilities and qualify for the $0 copayment?
People with Medicare and Medicaid who reside in long-term care
facilities may not have to pay copayments for their prescription drugs.
Pharmacies will receive a one-time payment for the amount of any
uncollected copayments for people who were mistakenly identified as
having to pay copayment amounts. The pharmacy will need to send the
prescription drug plan a spreadsheet with claim information. Processes
may vary among Medicare drug plans. Following the Medicare drug plan's
directions will help ensure timely reimbursements.
Question: What should people do if a higher premium amount is deducted from their Social Security benefit?
If there is a premium overpayment, such as when a person changes to a
lower premium plan and the premium change doesn't immediately go into
effect, Social Security will automatically refund the premium
overpayment. The person will get a refund check separate from his or her
regular monthly Social Security benefit. It may take two to three
months [or longer] to get a refund.
Question: Why would someone have two premiums deducted in one month?
People who enroll in a Medicare drug plan at the end of the month may
be charged in one month for multiple premium payments.
people who enrolled in a Medicare drug plan in the last two or three
weeks of December with an effective date of January 1, 20, may be
billed in February for both January and February premiums. Depending on
which payment method was selected, one of the following will occur:
- They will get a bill for 2 months of premiums. (Note: Plans
generally send bills at either the beginning or the end of the month. It
varies by plan.)
- They will have 2 months of premiums withdrawn from the selected
account. This could show as two separate withdrawal amounts, or one
withdrawal at double the amount, depending on the plan. (Note: These
withdrawals generally happen at either the beginning or the end of the
- They will have 2 months of premiums withheld from their monthly Social Security payment.
Question: What happens if a person who qualified for the low-income subsidy (LIS) is charged a premium?
People who qualified for the full LIS should generally pay no monthly
prescription drug premium [if they choose a Medicare Part D plan that
qualifies for their state's $0 premium LIS benchmark]. However, if they
select a plan that doesn't
have a $0 premium for people qualifying for the full LIS, they will have
to pay a small premium amount.
Also, if they join a Medicare drug plan
with supplemental benefits, they will pay the plan's supplemental
People who qualified for the partial subsidy may pay no premium
or a reduced premium for a basic plan, depending on income.
sponsors have been instructed not to bill a new member until Medicare
tells the plan what the member's premium should be. However, in some
cases, plans might mistakenly send bills for full plan premiums to
certain members who qualify for LIS or to members who qualify
retroactively for LIS. Plans also have been directed not to disenroll
members for failure to pay their premium bill if the person might
qualify for the full or partial LIS amount. People who get a notice that
says they will be disenrolled for non-payment of premiums should call
If the Medicare drug plan billed a member who should have a
reduced or $0 premium and the member paid the premium, the Medicare drug
plan will refund the amount overpaid as soon as possible. The member
can call the customer service number on the membership card, read the
plan's printed materials, or look on the plan's member website to find
out about the reimbursement process.
Question: What happens if people choose the premium withholding, but they also
have a secondary insurer that pays part of the drug plan premium?
People who get a premium benefit from a secondary insurer (a plan
other than their Medicare drug plan), such as an employer health plan or
a State Pharmacy Assistance Program (SPAP)
, will have the entire
monthly premium withheld if they choose the Social Security premium
withholding option. The Medicare drug plan will give the member a refund
for the amount the employer health plan or SPAP would have paid.
example, if a member with a $20 drug plan premium has a SPAP premium
benefit of $10 per month and the member chooses premium withholding,
Social Security will withhold the full $20. The Medicare drug plan will
refund the member $10. Plans shouldn't convert a member with secondary
coverage to direct billing, unless the member requests it, but they may
encourage members to choose this method of billing. If a member chooses
direct billing, he or she will get a bill for the correct premium
amount. The SPAP or employer will pay its share directly to the plan.
Question: What happens if a person is in a Medicare Advantage plan that
lowers the Medicare Part B premium, but the person is charged the full
Some Medicare Advantage Plans pay some or all of their members'
Medicare Part B premium as part of the plan's enrollment [such as Give-back or Dividend plans
]. It may take up
to 2 months for a member to see an increase in his or her Social
Security check equal to the amount of the reduction in the Part B
premium. If a member didn't see an increase, the incorrect withholding
amount will be repaid to the member all at once. Depending on the
payment method a member selected, one of the following will occur:
- They will have their regularly scheduled Social Security benefit payment increased.
- They will get a refund check from the plan or from Social Security.
The member should call his or her plan if the increase isn't received or refunded.
CMS Pub no.11246-P, "Repayment of Premiums and Copayments Paid
Out-of-Pocket", June, 2007 (with our additions and emphasis) - [update
08.28.2022: the document is no longer available online]