Lower prescription costs

If you meet certain income and resource limits, you may qualify for a program called 

Extra Help

 from Medicare to pay the prescription costs, premiums, deductibles, and coinsurance of Medicare prescription drug coverage. 

 

In 2019, prescription costs are no more than $3.40 for each generic/$8.50 for each brand-name covered drug for those enrolled in the program. In 2020, these costs will be no more than $3.60 for each generic/$8.95 for each brand-name covered drug.

 

Some people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level. 

 

In 2019, you may qualify if you have up to $18,735 in yearly income ($25,365 for a married couple) and up to $14,390 in resources ($28,720 for a married couple).

 

If you don't qualify for Extra Help, your state may have programs that can help with prescription costs. Contact your Medicaid office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.

Countable resources include:

  • Money in a checking or savings account
  • Stocks
  • Bonds

Countable resources don't include:

  • Your home
  • One car
  • Burial plot
  • Up to $1,500 for burial expenses if you have put that money aside
  • Furniture
  • Other household and personal items

Apply for Extra Help.

Some people automatically qualify for help with prescription costs

You automatically qualify for lower prescription costs through Extra Help if you have Medicare and meet any of these conditions:

Even if you automatically qualify this year, you may not qualify for Extra Help next year. Changes in your income or resources may cause you no longer to qualify for lower prescription drug costs through one of the programs listed above. You’ll get a notice (on grey paper) by the end of September if you no longer automatically qualify. Even if you get this notice, you may still qualify for help with prescription costs, but you need to apply to find out.

  • If your copayment amounts change next year, you'll get a notice (on orange paper) in the mail in early October with the new amounts.
  • If you don't get a notice from Medicare, you'll get the same level of Extra Help that you got for this year.

Paying the right amount for prescription drug coverage

If you're not sure if you're paying the right amount, call your drug plan. Your plan may ask you to give information to help them check the level of Extra Help you should get.

Can I get money back if I've been paying too much?

If you paid for prescriptions since you qualified for Extra Help and you aren't enrolled in Medicare prescription drug coverage, you may be able to get some money back. Keep receipts with your prescription drug prices, and call your plan. Or, you can contact 

Medicare's Limited Income Newly Eligible Transition (NET) Program at 1-800-783-1307 for more information (TTY: 711).

 

Other ways to lower prescription costs