Can You Save on Prescription Drugs When on Medicare?

Medicare drug coverage has limits, yet copays still sting. Here’s how to lower your out-of-pocket costs.

From Extra Help to discount cards, there are ways to cut prescription expenses before you hit the cap. Zamrznuti tonovi/Shutterstock

Although Medicare parts D and C provide prescription medication coverage, you may still face high costs. This can happen even with the new reforms. However, there’s a cap on annual out-of-pocket costs for prescriptions covered in Part D and Part C. According to the Centers for Medicare & Medicaid Services (CMS), the 2026 cap is $2,100.

But until you reach that cap, you’ll probably need to pay copayments and or coinsurance. Those charges can hit the wallet hard. Fortunately, there are ways to keep your prescription drug costs lower.

State and Federal Programs That Lower Costs

There are several ways to lower your prescription drug costs. If you have limited income and resources, you may be eligible for one or more federal or state programs. Private programs are also available.

Medicare Extra Help Saves $5,700 per Year

If you have limited income, Extra Help is a Medicare program that helps pay your Part D prescription drug costs. It will help with deductibles and copays.

You can apply for Extra Help anytime before or after you enroll in Part D.

Your income (from the prior year) and resources determine how much help you are eligible to receive. To qualify for Extra Help, according to the Social Security Administration (SSA), your resources must be limited to $18,090 per individual or $36,100 for a married couple living together. Your house isn’t considered a resource. Some people qualify for Extra Help automatically, while others must apply.

Those who receive Extra Help automatically include:

• full Medicaid coverage
• those receiving help paying Part B from a state Medicare Savings Program
• Supplemental Security Income (SSI) payments from Social Security

The SSA estimates that the Extra Help benefit is worth about $5,700 per year.

State Pharmaceutical Assistance Programs

According to the National Conference of State Legislatures, State Pharmaceutical Assistance Programs (SPAPs) are state-run financial assistance programs that help certain individuals pay for prescriptions. Coverage varies by state and specificity. Some SPAPs wraparound Medicare Part D coverage. This means that the SPAP will cover the cost of prescriptions that Part D doesn’t pay.

SPAP eligibility requirements vary by state. Some programs cover those who are unable to qualify for Medicare, while other SPAPs provide coverage for certain diseases.

Unfortunately, fewer than half of all states have SPAP for Medicare, according to the National Council on Aging (NCOA). Some states have coverage for specific diseases, such as renal or kidney disease. While others provide coverage for HIV/AIDS. To find out if your state has an SPAP for Medicare, go to Health Markets and choose your state.

State Discount Programs

There is also a subcategory of assistance programs known as state discount programs. States use their individual purchasing power to buy large quantities of various medications. The patient then pays the resulting discounted price at the pharmacy. Eligibility requirements vary by state.

Patient Assistance Programs From Drug Manufacturers

According to CMS, Patient Assistance Programs (PAPs) offer free or low-cost medications to uninsured or low-income patients. These programs are usually run by private pharmaceutical companies or nonprofit organizations. They usually apply to brand-name medications.

The downside to PAPs, according to the CMS, is that the discounted amounts the enrollee pays don’t count toward their Part D true-out-of-pocket cost (TrOOP). The TrOOP is important for determining if the enrollee has reached the threshold for catastrophic coverage under the Part D benefit.

Sources for PAPs include Rx Assist, NeedyMeds and the NCOA Benefits CheckUp.

Discount Drug Cards

Depending on the prescribed drugs you are purchasing, a patient can save up to 85 percent off the retail price, according to Healthline. Two of the most popular discount cards are SingleCare and GoodRx.

Although there are potential savings, it’s wise to have the pharmacist compare the difference between what your Part D plan will pay and what the discount card will pay.

And what you do pay is not applied to any deductibles or TrOOP.

There have been privacy concerns regarding discount drug cards. According to Consumer Report, in 2020, they discovered that GoodRx was sending personal details they had gathered from users to more than 20 other Internet-based companies without authorization.

Google, Facebook, and a marketing company called Braze were three companies that received the names of medications that people were researching on the card.

However, since that discovery, GoodRx now provides a way for users to delete their data.

But it should be noted that GoodRx wasn’t breaking the law. That’s because drug-discount companies are direct-to-consumer, and are generally not subject to the privacy standards of the Health Insurance Portability and Accountability Act (HIPAA). This makes it legal for them to share and sell users’ personal information according to the College of Pharmacy.

Medicare Prescription Payment Plan

The Medicare Prescription Drug plan doesn’t save money; it’s a vehicle to help manage out-of-pocket costs for prescription drugs, according to Medicare.

When you fill a prescription for a drug covered by Part D, you won’t pay your pharmacy (including mail order and specialty pharmacies). Instead, you’ll receive a bill each month.

You’ll still be responsible for the bill, but this payment option might help you manage monthly expenses.

Options for Paying Out-of-Pocket Prescription Drug Costs

If you’re struggling to pay for your prescription medications, you have options. From federal and state programs to pharmaceutical manufacturers and discount drug cards, you can control your prescription medications’ costs.

If you don’t qualify for these plans or don’t want to use a discount card, the Medicare Prescription Payment Plan may be an option to spread out your prescription payments.

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