If your prescriptions eat up a big part of your budget, you are not stuck with whatever the pharmacy rings up. There are programs built for exactly this, and many people who qualify never apply. Some help with the monthly premium, some cut your copays, and one spreads your costs out so a big January bill does not wreck your month.
Here are the main ways to get help paying for Medicare drug costs, and who each one is for.
First, know your cap
Medicare Part D now has a yearly limit on what you pay for covered drugs. For 2027, once your out-of-pocket costs reach $2,400, you pay nothing more for covered drugs for the rest of the year. Covered insulin is capped at $35 a month.
That cap protects you from the worst case, but $2,400 is still a lot of money for people on a fixed income. The programs below help with what comes before the cap.
Extra Help
Extra Help, also called the Low-Income Subsidy, is a federal program that lowers your Part D costs. If you qualify, it can:
- Pay all or most of your drug plan premium
- Remove your Part D deductible
- Lower your copays to small, set amounts
- Give you more chances during the year to change drug plans
Extra Help is based on your income and savings. The limits are higher than most people expect, and your home, one car, and a burial plot do not count as savings. If you are on the fence, apply. It costs nothing.
You get Extra Help automatically if you have full Medicaid, get Supplemental Security Income, or are enrolled in a Medicare Savings Program. Everyone else applies through Social Security, online, by phone, or at a local office.
Medicare Savings Programs
Medicare Savings Programs are run by your state. They pay your Part B premium, and some also pay your Part A and Part B deductibles and coinsurance. Qualifying for one automatically qualifies you for Extra Help, so this is often the best place to start.
See Medicare Savings Programs explained for how the programs work.
The Medicare Prescription Payment Plan
This one does not lower your total cost, but it can make it manageable. Instead of paying large amounts at the pharmacy early in the year, you pay $0 at the counter and get a monthly bill from your drug plan that spreads your costs across the rest of the year.
- Anyone with a Part D plan or a Medicare Advantage plan with drug coverage can join.
- There is no cost to join, and no interest or fees.
- It helps most when your drug costs are high early in the year.
- You sign up through your drug plan.
If you are already getting Extra Help, you usually do not need it, because your copays are already low.
State programs
Some states run their own State Pharmaceutical Assistance Programs that help with drug costs or Part D premiums. Others offer help only for certain conditions. The rules and names vary by state.
Your State Health Insurance Assistance Program, or SHIP, can tell you what is available where you live. It is free, unbiased counseling. You can find yours through Medicare.gov or by calling 1-800-MEDICARE.
Drug company assistance programs
Many drug makers run patient assistance programs that provide brand-name drugs free or at a low cost to people with limited income. Some accept people with Medicare. Ask your doctor’s office, because they often know which programs cover the drugs they prescribe.
One thing to know: manufacturer copay coupons, the cards you see in TV ads, generally cannot be used with Medicare drug coverage. Patient assistance programs are different and can work alongside it.
Simple ways to lower your costs
- Ask about generics. A generic or a different drug in the same class can cost far less.
- Use a preferred pharmacy. Most drug plans charge less at certain pharmacies.
- Try 90-day or mail-order fills. Many plans charge less for a 3-month supply.
- Compare discount card prices for cheap generics, but understand the tradeoff first. See GoodRx vs. your Part D plan.
- Review your drug plan every year. The plan that was cheapest this year may not be next year. AEP runs October 15 to December 7.
Common questions
Does Extra Help affect my Social Security?
No. Extra Help lowers what you pay for drugs. It does not reduce your Social Security benefit.
Can I get Extra Help if I own my home?
Yes. Your home does not count toward the savings limit.
Do I need to reapply every year?
Social Security may review your eligibility from time to time and will contact you if it does. If you get Extra Help through Medicaid or a Medicare Savings Program, it continues as long as you keep that coverage.
Let us check what you qualify for
We can look at your drugs, your plan, and the programs you may qualify for, at no cost. Start with the Medicare Clarity Score, which takes about three minutes, or call Scott at 512-844-3983. You can also see our Medicare drug plan help page.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not affiliated with or endorsed by the federal government or the federal Medicare program.