I'm worried about affording my medications even with the 2025 changes. Are there additional assistance programs I should know about?

Question

Diana Garner · Accepted Answer

Even with the coverage gap being eliminated and a max of $2000 out-of-pocket being set, medications can still be costly.

Medicare Beneficiaries can:
1) Apply for the Low-income Subsidy (extra help) through Social Security 
2) Apply for the state-based program called the Medicare Savings Program
3) Apply for patient assistance programs offered by the drug manufacturers or non-profit organizations.

Tammera Marrs · Answer

There are some Federal and State progams. Pharmacy programs, Discount programs, and Patient Assistance programs. So far my clients have been able to afford their prescriptions. Some clients have had help with one of the programs mentioned above. The out of pocket change of $2,000 for formulary covered prescriptions on the prescription drug plan (Plan D) has helped.

Answered by Tammera Marrs on May 1, 2025

Broker Licensed in KS

Answered by Tammera Marrs Medicare Insurance Agent

Steve Houchens · Answer

Depending on you financial situation you could possibly be eligible for LIS or low income subsidy or possible or help available and I feel it’s always worth checking for any extra help you qualify for.

Answered by Steve Houchens on June 16, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

Yasmery Vargas · Answer

Yes. There are various programs through your local state that help with premium costs and reducing prescription costs. In Pennsylvania a good example is PACE/PACENET or Extra Help through social security. M3P Payment plan is also available.

Answered by Yasmery Vargas on May 15, 2025

Agent Licensed in PA

Answered by Yasmery Vargas Medicare Insurance Agent

Diana Salisbury · Answer

Yes, you can check to see if you qualify for Extra Help through Social Security, or apply for pharmaceutical assistance through the manufacture of the prescription.

Rosalind Ryan · Answer

Even with the 2025 $2,000 out-of-pocket cap on Medicare Part D, there are several additional programs that can help lower your medication costs. Consider using GoodRx for discounts, applying for patient assistance programs through drug manufacturers, checking your eligibility for state pharmaceutical assistance programs, and exploring Medicare’s Extra Help (Low-Income Subsidy) program. You can also save by using generics, mail-order pharmacies, or choosing a different Medicare Part D plan during open enrollment.

Answered by Rosalind Ryan on June 4, 2025

Broker Licensed in GA, AL, FL & 8 other states

Answered by Rosalind Ryan Medicare Insurance Agent

Peter Joseph · Answer

Yes there are things you can do. You can apply thru social security for low income subsidy. You can also reach out to your insurance carrier to pay it over time (a period of a year). This doesn’t reduce your costs but there’s no interest and copays would be lower since they are spread out over 12 months. Please see me for more details.

Answered by Peter Joseph on April 14, 2025

Broker Licensed in CA, AL, AR & 37 other states

Answered by Peter Joseph Medicare Insurance Agent

Steve Brauer · Answer

If you fall into certain income brackets, you would be eligible for what they call Extra Help. It would either pay part, or all of your medications, copays and other charges. You would check with Social Security to see if you qualify.

Answered by Steve Brauer on April 16, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Fran Lovelace · Answer

You can go to Mecicare.gov and search "extra help"  Depending on your financial situation, you may qualify for extra help.  If so, you can apply there.
Also, some states have pharmaceutical assistance programs.
  For 2025 the maximum out of pocket for covered drugs is $2,000.00.  There is also a monthly payment program that you can set up this year with your Rx carrier.

Judi Norton · Answer

Yes.  Many of the Insurance companies that provide prescription drug coverage have programs to level out your payments for the year.

Mark Murphy · Answer

A lot of states offer Senior Prescription Assistance programs (SPAPs) to help with prescription costs. In NJ we call that program PAAD (Prescription Assistance for the Aged and Disabled). It is a state program where your qualification is based on your yearly income. The income levels increase just about every year so it's always good to continue to check the site for updates.

Answered by Mark Murphy on April 9, 2025

Agent Licensed in NJ, AL, CO & 9 other states

Answered by Mark Murphy Medicare Insurance Agent

Virginia Barausky · Answer

Visit SSA.gov/extrahelp or call 1‑800‑772‑1213
There are also state programs that may be able to assist you, find an agent to help  you.

Casey Peterson · Answer

There are. Speaking with the drug manufacturers to see if you qualify, asking your prescribing doctor for samples, seeing if you qualify for assistance from your state or from the federal government, as well as other options.

Answered by Casey Peterson on April 8, 2025

Broker Licensed in ID, AZ, CO & 6 other states

Answered by Casey Peterson Medicare Insurance Agent

Tony Evangelista · Answer

Yes! There are a number of programs both at the state level and federal level. We do the hard work for you on getting you assistance to qualify for these.

Alison Grice · Answer

There are state and federal programs available to help cover the cost of your prescriptions, if you qualify. One such program is the Part D Extra Help program through social security. There are also various Medicaid programs that can help offset or cover the costs of your prescriptions as well and are dependent on the state you live and other qualifications. The Medicare Prescription Payment plan might be another option someone could consider. There are other programs as well out there and your trusted Medicare specialist can help point you in the direction of these resources as well as your providers and pharmacy.

Answered by Alison Grice on May 19, 2025

Broker Licensed in SC, CO, FL & NC, TN, TX & WY

Answered by Alison Grice Medicare Insurance Agent

I'm worried about affording my medications even with the 2025 changes. Are there additional assistance programs I should know about?

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I'm worried about affording my medications even with the 2025 changes. Are there additional assistance programs I should know about?

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