Numerous programs may help reduce your health care and Prescription Drug A prescription drug is a drug that can be obtained only if you have a prescription from a provider. Prescription drugs cannot be bought over the counter. Â costs if you meet the eligibility requirements.
Programs that provide assistance with health care costs:
- Medicaid: If you have a low monthly income and few Assets Assets are resources such as savings and checking accounts, stocks, bonds, mutual funds, retirement accounts, and real estate. , you may be eligible for coverage through Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. to pay for Medicare Medicare is the federal government health insurance program that provides health care coverage if you are 65 or older, are under 65 and receive Social Security Disability Insurance (SSDI) for 24 months, begin receiving SSDI due to ALS/Lou Gehrig’s Disease, or have End-Stage Renal Disease (ESRD) no matter your age. You can receive health coverage directly through the federal government (see Original Medicare) or through a private company (see Medicare Advantage).  costs, like copayments and deductibles, and for health care not covered by Medicare, such as dental care and transportation to medical appointments.
- Medicare Savings Programs (MSP): If you have a low monthly income, you may qualify for an MSP, a program that helps pay Medicare costs.
- Low-cost health centers and clinics: You may pay less for Medicare-covered services if you receive them through low-cost health centers and clinics in your state. For more information, contact your State Health Insurance Assistance Program (SHIP).
Programs that provide assistance with prescription drug costs:
- Extra Help: Also known as the Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. Low-Income Subsidy (LIS) See Extra Help. , this federal program that helps individuals with low incomes pay for costs of Medicare prescription drug coverage. If you are enrolled in Medicaid, an MSP, or you receive Supplemental Security Income (SSI) Supplemental Security Income is a monthly benefit for people with limited incomes and assets who are 65 or older, blind, or have a disability. , you should get Extra Help Extra Help, also known as the Part D Low-Income Subsidy (LIS), is a federal program administered by Social Security that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage, including coinsurances, deductibles, and premiums. People with Medicare who have income and assets below specified limits are eligible for Extra Help, which has different levels. Depending on your income and assets, you may qualify for either full Extra Help or partial Extra Help. People may also be automatically enrolled in Extra Help if they have certain other types of coverage, even if their income and assets are above the set levels.  automatically. You can apply for the Extra Help program through the Social Security Administration (SSA) or your local Medicaid office.
- State Pharmaceutical Assistance Programs (SPAPs): Offered in some states to help pay for prescriptions, most SPAPs have income guidelines. Many also require you to enroll in a Medicare Part D plan and to apply for Extra Help. SPAPs generally pay or help pay for the Part D and any Cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. , as well as offering lower costs while you are in the Donut Hole See Coverage Gap. . Some SPAPs may also pay for drugs that are excluded from Medicare Part D or are not included in your plan’s Formulary The formulary is the list of prescription drugs covered by a Part D plan or Medicare Advantage Plan. If your drug is not on the formulary, you may have to request an exception, file an appeal, or pay out of pocket. .
- Charity programs: There may be charities that can help reduce your Prescription A prescription is an order for a health care service or drug written by a qualified health care professional. costs. If you have Part D, in some cases the amount the charity pays counts toward your Catastrophic Coverage Catastrophic coverage is a phase of coverage designed to protect you from having to pay very high out-of-pocket costs for prescription drugs. It usually begins after you have spent a pre-determined amount on your health care. For example, Part D prescription drug plans offer catastrophic coverage. After you have spent a certain amount out of pocket, you owe no cost-sharing for the cost of your covered drugs for the remainder of the year. limit.
- Patient Assistance Programs (PAPs): You may be eligible to get free or low-cost drugs directly from the company that makes them, through a PAP. In most cases, your doctor must apply for you. Not all PAPs allow you to apply if you are eligible for Part D.
- If you are enrolled in a PAP, you may be required to pay a Copayment A copayment, also known as a copay, is a set amount you are required to pay for each medical service you receive (like $35 for a doctor’s visit). . PAP copays will count toward your Part D plan’s Out-of-Pocket Limit See Maximum Out-of-Pocket (MOOP). ($8,000 in 2024), but you will need to submit your receipts and any other required documentation to your plan. The amount your PAP pays for your prescription drugs will not count toward your out-of-pocket limit.
- Prescription drug discount programs: You may be able to get medications you need at a reduced price from national or local discount programs. Note that you cannot use a prescription drug discount program and Part D coverage at the same time: you must select between them at the pharmacy.
- If you have Part D, it is best to use your discount card during your plan’s Deductible The deductible is the amount you must pay for health care expenses before your health insurance begins to pay. Deductible amounts can change every year. and Coverage Gap The coverage gap, also known as the Medicare Part D donut hole, is the phase of Part D coverage after your initial coverage period. As a result of the Affordable Care Act (ACA), the coverage gap was phased out in 2020. Your drug costs may still change when you enter the coverage gap, after your initial coverage period, but you will pay no more than 25% of the cost of your drugs in the coverage gap.  periods. This is because during these periods, the amount you pay for drugs on your plan’s formulary may count toward meeting your out-of-pocket maximum. Be sure to tell your pharmacist not to bill your Part D plan. You will also need to submit your receipts and any other required documentation to your plan in order for the costs to be counted toward your out-of-pocket maximum.
- Safety net providers: Pharmacies in certain government-funded hospitals and community health centers may provide medication at lower costs or charge you based on your income. These centers and clinics include federally qualified health centers (FQHCs) and rural health clinics (RHCs). Some centers may waive copays for drugs covered by your Part D plan if you request assistance. Be sure to contact the facility directly to learn which benefits it offers and which costs may count toward reaching your out-of-pocket maximum.