The stress of affording your medication is a familiar feeling for too many people. Although this year brings the new $2,000 cap on Part D spending, there are other ways, too, to help you lower your Part D costs. Let’s review four cost-saving programs and strategies:
1. The Extra Help program
Extra Help is a federal program that helps pay for your out-of-pocket costs with Medicare prescription drug coverage. Your income and assets determine if you are eligible. The monthly income limit is around $2,000 for individuals and around $2,700 for couples. The asset limit is nearly $18,000 for individuals and around $35,000 for couples. Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help, because certain types of income and assets may not be counted. You automatically qualify for Extra Help if you have Medicaid, Supplemental Security Income, or a Medicare Savings Program.
The Extra Help program pays for your Part D premium for a basic Part D plan up to a state-specific benchmark amount. It also lowers the costs of your prescription drugs. People with Extra Help have more flexibility to change their Part D plans through Special Enrollment Periods throughout the year. Finally, if you delayed Part D enrollment and have a late enrollment penalty, Extra Help eliminates your Part D late enrollment penalty.
Remember that Extra Help is not a replacement for Part D or a plan on its own. You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.
2. State Pharmaceutical Assistance Programs (SPAPs)
Many states offer State Pharmaceutical Assistance Programs, which are called SPAPs for short. SPAPs help state residents pay for prescription drugs, but each program works differently. States may coordinate their drug assistance programs with Part D. Some SPAPs require that you sign up for Part D in order to qualify for assistance. Your SPAP may help pay for your Part D plan’s premium, deductible, or copayments. Certain states have qualified SPAPs. Qualified SPAPs provide a Special Enrollment Period to allow you to enroll in or make changes to your Part D or Medicare Advantage coverage. To learn if your state has an SPAP and find out if you qualify, call your State Health Insurance Assistance Program, or SHIP. Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
3. Work with your doctor or pharmacist
Whether or not you qualify for Extra Help or an SPAP, you may have other options to help save on high drug costs:
4. National or local discount programs
You may be able to get medications at a reduced price for national or local discount programs, which you can find on NeedyMeds.org or GoodRx.com. You might also be eligible for free or low-cost drugs directly from the company that makes them. These programs are called Patient Assistance Programs, or PAPs. In most cases, your doctor applies for you. Be aware that some of these coupons and discount programs may not be available to people with Medicare or may not work with your Part D plan, which means that the amount you pay will not count toward the $2,000 cap on your Part D costs.
Still have questions?
Your SHIP is here for you! You can contact your SHIP for any Medicare-related questions or concerns you have. SHIP counselors are government funded to provide trusted, unbiased Medicare counseling at no cost to you. (Depending on your state, your SHIP may go by another name.) Use our online SHIP Locator or call 877-839-2675 (and say “Medicare” when prompted) to find your local SHIP.
If you think you have experienced potential Medicare fraud, errors, or abuse contact your local Senior Medicare Patrol using the online SMP Locator or by calling 877 808-2468.
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