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Are there programs to help me pay for my prescription drugs?

The costs of prescription drugs can be very high, and I am sorry to hear it is causing you stress. There are some programs to help with these costs and I'm happy to tell you about them!

Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. If you are enrolled in MedicaidSupplemental Security Income, or a Medicare Savings Program, you will automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. If you are not enrolled in these programs, the eligibility requirements (and benefits) are below:  

Full Extra Help 

Eligibility (for those not automatically enrolled) 

  • Monthly income limit: $1,469 for an individual and $1,980 for couples 
  • Asset limit: $9,470 for an individual and $14,960 for couples 


  • $0 premium and deductible 
  • $3.70 generic copay 
  • $9.20 brand-name copay 
  • No copay after $6,550 in out-of-pocket drugs 

Partial Extra Help  

Eligibility (for those not automatically enrolled) 

  • Monthly income limit: $1,630 for an individual and $2,198 for couples 
  • Asset limit: $14,790 for an individual and $29,520 for couples 


  • Premium depends on your income 
  • $92 deductible or the plan’s standard deductible, whichever is cheaper 
  • 15% coinsurance or the plan copay, whichever is less 
  • After $6,550 in out-of-pocket drug costs, you pay $3.70 per generic and $9.20 per brand-name or 5% of the drug cost, whichever is greater 

You can apply for Extra Help through the Social Security Administration (SSA). Visit or call 800-839-2675 to learn more. For assistance with the Extra Help application, call the Medicare Rights Center helpline at 800-333-4114.  

State Pharmaceutical Assistance Programs (SPAPs) are offered in some states to help pay for prescriptions. Each program works differently and has different requirements for eligibility. 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 premium and any cost-sharing, as well as offer lower costs while you are in the donut hole. Some SPAPs may also pay for drugs that are excluded from Medicare Part D or are not included in your plan’s formulary. To learn if your state has SPAP and find out if you qualify, call your State Health Insurance Assistance Program (SHIP). You can find your SHIP by calling 877-839-2675 or visiting

If you do not qualify for these programs, check out these other options and strategies for those who are having trouble affording drug costs


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Posted May 25, 2021 by at United States in Medicare
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