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

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.

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 & 39 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

Judi Norton · Answer

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

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

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

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.

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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