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How to Get Extra Help Paying for Medicare Prescriptions

Use the free tool — Prescription Price Cutter

Worried About What Your Prescriptions Cost?

Type the drug, the dose, what you pay, and your coverage. In a few seconds you get the cheaper paths that exist for that drug and that coverage, in order, what each needs, and what to say at the counter. Never stop or switch a medicine without the prescriber. No account. Nothing stored.

What Is Extra Help?

Extra Help is the name for the Medicare Part D Low-Income Subsidy. It pays most of your Part D drug costs if you have limited income. It is not automatic — you have to apply.

• Apply for free directly with Social Security: SSA — Extra Help with Medicare drug costs.

The $2,000 Cap and the $35 Insulin Cap

Medicare Part D has a $2,000-a-year cap on what you pay out of pocket for covered drugs. Insulin covered under Part D or Part B is capped at $35 a month. These caps apply whether or not you also qualify for Extra Help.

• See details: Medicare.gov — Part D costs.

If a Drug Isn't Covered, or Costs Too Much, on Your Plan

You or your prescriber can ask your Part D plan for a formulary exception or a tiering exception. This usually needs a letter from your prescriber. Every fall, from October 15 to December 7, you can compare Part D plans against your actual drug list using Medicare.gov's Plan Finder.

Florida SHINE gives free, unbiased Medicare counseling for all of this. Call 1-800-963-5337, or visit Florida SHINE.

Other Ways to Lower the Price

• Ask your prescriber whether a generic or a different drug in the same class is appropriate for you. FDA-approved generics must meet the same standards as the brand-name drug — see FDA — Generic drug facts.
• Search manufacturer and charity assistance programs for your drug by name at NeedyMeds' Medicine Assistance Tool.
• If you're uninsured, look for a community health center — many charge by income and may have lower-cost 340B pharmacies: HRSA — Find a health center.
• Discount cards can sometimes beat an insurance copay, but ask the pharmacist — a card usually can't be combined with insurance on the same fill, and that fill may not count toward your deductible.

If You're Skipping Doses Because of Cost

Tell your prescriber and your pharmacist today. They can often help the same day. Never stop, skip, split, or change a medicine or dose on your own.

What to Do Next

The free Prescription Price Cutter tool reads the drug, the dose, what you pay, and your coverage that you type in — Medicare, Medicaid, employer plan, or none — and shows you, in order, the cheaper paths that apply, what each one needs, and what to say at the pharmacy counter and to your prescriber.

Prescription Price Cutter is not a pharmacist or a doctor and can be wrong. Never stop, skip or change a medicine without your prescriber. Confirm programs and prices with your pharmacist, SHINE (Medicare), or your clinic.

Prescription Price Cutter explains ways to lower prescription costs in plain language from official sources; it can be wrong, and it is not medical, pharmacy or insurance advice. It never states a drug price. Talk to your prescriber before any change. Nothing you type is stored.