How to Save on Prescription Drugs with Medicare: Available Programs to Help Reduce Your Costs

Prescription drug costs are one of the biggest concerns for many Medicare beneficiaries. While Medicare Part D provides prescription drug coverage, the out-of-pocket costs for medications can still add up quickly—especially for high-cost drugs. Fortunately, there are several programs available that can help reduce these costs and make prescriptions more affordable.
In this blog, we’ll explore the different programs that can help lower your medication costs, including Extra Help, State Pharmaceutical Assistance Programs (SPAPs), Manufacturer Discount Programs, and more.
One of the most well-known and beneficial programs for Medicare beneficiaries is Extra Help. Also known as the Low-Income Subsidy (LIS), Extra Help is a federal program designed to help people with limited income and resources pay for prescription drugs under Medicare Part D

1. Extra Help: Financial Assistance for Prescription Drugs

What Does Extra Help Cover?

  • Covers premiums: Extra Help can assist in paying for your Part D premium, reducing your monthly cost.
  • Covers deductibles and co-pays: Extra Help can reduce your deductibles and co-pays for prescription medications, making them more affordable.

Eligibility Requirements for Extra Help

  • Income: You must have a limited income. In 2025, the income limits for Extra Help are $19,140 for an individual and $25,260 for a married couple living together.
  • Resources: You must have limited resources, typically under $15,000 for an individual or $30,000 for a married couple.
  • Apply online: You can apply for Extra Help through Social Security online, by phone, or at your local Social Security office.

2. State Pharmaceutical Assistance Programs (SPAPs)

Some states have their own State Pharmaceutical Assistance Programs (SPAPs) that help Medicare beneficiaries pay for prescription drugs. SPAPs are available in certain states and may provide additional assistance for Medicare Part D premiums or co-pays.

What Do SPAPs Cover?

  • Premium assistance: SPAPs can help pay for your Medicare Part D premium, making prescription drug plans more affordable.
  • Co-pay assistance: SPAPs can also help reduce the out-of-pocket co-pays for prescriptions.

How to Apply for SPAPs

  • Eligibility Each state has different eligibility criteria based on income and other factors. Many states require you to be enrolled in Medicare and meet certain income thresholds.
  • Contact your state: To apply for SPAPs, visit your state’s official website or contact the State Health Insurance Assistance Program (SHIP) for guidance.

3. Medicare Part D Prescription Drug Plan (PDP) Coverage Comparisons

While this isn’t a program per se, it’s worth mentioning that different Part D plans offer varying levels of coverage, and comparing these options can help you save money.

What to Consider When Comparing Plans:

  • Drug formulary: Some plans cover certain medications at a lower cost than others, so reviewing the formulary (list of covered drugs) is important.
  • Premiums and co-pays: Plans may have different premium and co-pay structures. It’s worth comparing multiple options to find one that offers the most affordable prescription coverage for your needs.

How to Compare Plans:

  • Use the Medicare Plan Finder tool to compare Part D plans, including costs, coverage, and formulary options.
  • Consider talking to a Medicare advisor to help guide you through the options.

4. Manufacturer Discount Programs

Many drug manufacturers offer discount programs for specific medications, especially for high-cost drugs like Ozempic and Mounjaro. These programs are often available for people who don’t have insurance or have high out-of-pocket costs.

What Do Manufacturer Discount Programs Offer?

  • Reduced medication costsThese programs can provide discounts on high-cost prescription medications, especially those used for chronic conditions like diabetes or heart disease.
  • Free medication for those who qualify: Some programs even offer medications for free to people who meet certain income and eligibility requirements.

How to Apply for Manufacturer Discounts

  • Visit the manufacturer’s website: Many pharmaceutical companies have dedicated websites where you can apply for discounts on their drugs.
  • Ask your doctor: Your doctor may be aware of discount programs for specific medications and can help you apply.

5. The Low-Income Subsidy for Dual Eligible Beneficiaries

If you’re dual eligible —meaning you qualify for both Medicare and Medicaid —you might be eligible for additional financial assistance with your prescription drugs. Dual eligible beneficiaries are automatically enrolled in the Part D Extra Help program, which can further reduce the cost of medications.

What is Available to Dual Eligible Beneficiaries?

  • Lower premiums, co-pays, and coinsurance: Dual eligible beneficiaries can receive comprehensive prescription drug coverage at little to no cost.
  • Full prescription drug coverage: In many cases, dual eligible beneficiaries receive the full benefits of Medicare Part D with minimal or no out-of-pocket expenses.

Final Thoughts: Don’t Let Prescription Costs Hold You Back

The cost of prescription medications doesn’t have to break the bank. Whether it’s through Extra Help, SPAPs, manufacturer discounts, or simply comparing Part D plans, there are several ways to reduce your out-of-pocket costs and get the medications you need.
If you’re unsure which program is right for you, don’t hesitate to reach out to your Medicare advisor. They can guide you through the process, help you understand your options, and ensure you’re taking full advantage of any programs that can reduce your costs.

Choosing the Right Medicare Coverage

Selecting the best Medicare coverage depends on factors like your healthcare needs, budget, and preferred providers. You can choose between:
  • Original Medicare (Parts A & B): Allows you to see any doctor or
    hospital that accepts Medicare but does not include prescription drug
    coverage (Part D) or additional benefits.
  • Medicare Advantage (Part C): Offers bundled coverage with
    potential extra benefits but may require using a network of providers.
  • Medigap (Medicare Supplement Insurance): Helps cover
    out-of-pocket costs not covered by Original Medicare, such as
    copayments and deductibles.

Key Medicare Enrollment Periods

It is crucial to enroll in Medicare at the right time to avoid penalties and ensure continuous coverage:
  • Initial Enrollment Period (IEP): A seven-month window starting
    three months before your 65th birthday month.
  • General Enrollment Period (GEP): From January 1 to March 31
    each year for those who missed their IEP.
  • Annual Election Period (AEP): From October 15 to December 7,
    allowing you to switch or enroll in Medicare Advantage and Part D
    plans.
  • Open Enrollment Period(OEP): From January 1 to March 31 for
    those who missed AEP and want to make certain changes.
  • Special Enrollment Period(SEP): Can be used anytime during the
    calendar year for those that meet certain criteria such as moving to a
    new service area.

Finding Help with Medicare

Understanding Medicare can be complex, but you don’t have to do it alone. Licensed Insurance Brokers, Medicare.gov, and state health assistance programs can provide guidance tailored to your specific needs.
By taking the time to explore your Medicare options, you can make informed decisions that ensure you receive the healthcare coverage that best suits your lifestyle and budget.
Do I have to sign up for Medicare?
It depends upon your current coverage. If you are employed and your employer has over 20 employees then you can delay signing up for Medicare and avoid penalties.
No, You will have to enroll in a stand alone Part D plan or a Medicare Advantage Plan(Part C) to get coverage.
There are no networks with Medicare and most doctors and hospitals accept it. However, Medicare does not cover 100% of services so a Medicare Supplement or Medicare Advantage plans is advisable.

Mike Miligi- Owner

For over 10 years, Mike has been assisting Seniors and other Medicare-eligible individuals in understanding the ins and outs of Medicare and Medicare Health Insurance options, including Medicare Advantage Plans(Part C), Medicare Supplement Plans(Medigap), Prescription Drug Plans(PartD), and Dental and Vision programs.
Mike is Licensed in seven States and Certified with 11 Insurance Carriers. He has helped thousands of individuals decide on the best course of action for their particular Health Insurance needs. Because Mike is an Independent Medicare Health Insurance Broker, he works for the client, not the Insurance Carriers, and is able to provide his clients with accurate and unbiased Health Insurance options.
Mike recertifies with CMS(The Centers for Medicare and Medicaid Services) annually, regularly completes Continuing Education Courses required by individual State Insurance Departments, and keeps abreast of industry trends and standards to offer his clients the most up-to-date information.
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