Prescription medications often become one of the more expensive components of healthcare. Even with coverage through Medicare Part D, these costs quickly add up, especially for individuals with monthly prescriptions. Fortunately, several programs exist to help people more easily afford their prescription medications.
Patient Assistance Programs
Sometimes called PAP, patient assistance programs provide free or low-cost medications directly from the pharmaceutical company producing them. Not all companies participate in PAP, but many do, including some that allow Medicare Part D recipients to apply.
Typically, the company requires that your doctor complete the application process. In addition, you may have a co-pay requirement. If you have Part D, this co-pay counts toward your annual out-of-pocket limit as long as you submit the required documentation, such as receipts. Keep in mind that the PAP’s portion will not count toward your out-of-pocket limit.
The Extra Help Program)
A federal program designed to help Medicare Part D recipients with medication costs, Extra Help is available upon meeting certain financial requirements. As of 2016, qualified individuals must have:
- Monthly income below $1,505 for singles and $2,022 for married couples
- Assets, including checking, savings, and retirement accounts, below $13,640 for singles and $27,250 for married couples
Anyone may apply for Extra Help, even if their income or assets exceed the set limits. Those who qualify may register for Part D – even after enrollment ends – without incurring a penalty.
If you are enrolled in Medicaid, receiving Supplemental Security Income (SSI), or enrolled in Medicare Savings Programs (MSPs), you automatically qualify for Extra Help. Whether you receive a partial subsidy or a full subsidy depends on your income. Medicare only pays premiums for drug plans at or below the regional benchmark.
Prescription Discount Programs
You may choose to join one of the national or local discount drug programs. However, you may not use the discount program as well as your Medicare Part D benefits together. Be sure to let your pharmacy know which plan you want to use for each transaction.
In many cases, Medicare Part D will save policyholders more until they reach their plan’s gap period. Once the gap period is reached, a discount card will likely saves more money.
At this point, expenses for covered prescriptions begins counting toward your out-of-pocket maximum. Tell the pharmacist not to use Medicare coverage for these prescriptions. Then, submit the required documentation, such as receipts, to your plan. Dial the service number listed on your Medicare Part D card for a list of required documentation.
Medicaid and Medicare Savings Programs
Beneficiaries with income below the Medicaid threshold may qualify for Medicaid’s drug coverage. Membership in both Medicare and Medicaid typically requires enrollment in Medicare Part D, and you automatically receive Extra Help.
Even if your income level is too high for Medicaid, you may qualify for the Medicare Savings Program (MSP). It does not cover prescriptions. Instead, it frees up money by helping pay your Medicare premiums and deductibles.
MSP enrollment, along with receiving SSI benefits, automatically qualifies you for Extra Help, with no application necessary.
Beginning in 2006, Medicare recipients who receive coverage under both Medicare and Medicaid (“dual eligible”) no longer receive prescription drug coverage under Medicaid. Instead, they must enroll in a plan themselves. If you do not select a plan, the Department of Health and Human Services (DHHS) will choose one on your behalf.
Those enrolled in traditional Medicare (Parts A and B) are in a standalone drug plan, one with a premium at or below your area’s standard plan premium. If you chose a Medicare Advantage plan, such as an HMO or PPO, DHHS will enroll you in the lowest premium prescription drug plan available with your insurer.
If you do not choose a plan and instead have one assigned to you, check to make sure the plan covers both the prescriptions you take and the pharmacy you visit. If it does not, you may change your drug plan. Typically, you may only change your prescription drug plan during the Annual Open Enrollment Period. However, if your plan does not cover a drug you need, you may change it once per month.
State Pharmaceutical Assistance Programs (SPAPs)
Some states offer programs to help residents save money on prescription drugs. Typically, these state programs (SPAPs) work with Medicare and require enrollment in Medicare Part D before you qualify for state assistance. To see if you qualify for help with your out-of-pocket prescription costs through an SPAP, select the link above or contact your State Health Insurance Assistance Program.
There are numerous avenues to assist you in paying for your prescription drugs. Those costs can grow quickly, so don’t hesitate. Contact someone for help today.