Extra Help Paying Prescription Drug Costs

Paying premiums, deductibles, and copays can sometimes be tough. Luckily, there are programs available that can give extra help covering your healthcare and prescription drug expenses. If you are on Medicare and have a limited income, you may qualify for some of these programs.

The Extra Help Program is a Federal Medicare program created to help people pay for their Medicare (Part D) Prescription Drug plan costs. This program is also known as Part D Low-Income Subsidy (LIS). If your income is below a certain level, you can get help with your prescription drug premiums, copays, and even deductibles. If you get “Extra Help,” you won't have to pay a Part D late penalty. There are income and resource requirements to qualify for this program.

Who Is Automatically Enrolled?

The good news is that many people are automatically enrolled in the “Extra Help” Program if they receive:

• Medicaid
• Supplemental Security Income (SSI)
• State help paying Part B premiums (Medicare Saving Program)

Applying for Extra Help

If you don’t automatically qualify for “Extra Help,” you can apply for this program through the Social Security Administration. You can find more information about the “Extra Help” program on ssa.gov.

Getting extra help paying for prescriptions can lower your costs, making your medications more affordable. This means you can get the medicine you need without worrying about the high price, which could help you stay healthier.
 

If you live in New Jersey, you may have access to the Pharmaceutical Assistance to the Aged and Disabled program, also known as PAAD. This state-run program helps pay for prescription drugs for seniors and people with disabilities. It’s a great resource if your income is low or moderate. PAAD works with your Medicare Part D plan to lower what you pay at the pharmacy.

If you qualify for PAAD, you may also be eligible for other state programs that help with energy bills, property taxes, and more. You can visit medicare.gov to see the other assistance programs available in your state.

Five Additional Programs That Provide Help

Medicare Savings Programs (MSPs): These programs help pay for your Medicare costs if you have limited income. There are four types of MSPs, like the Qualified Medicare Beneficiary (QMB) program, which covers premiums and copayments. To apply, contact your state’s Medicaid office online or by phone.

State Health Insurance Assistance Programs (SHIPs): SHIPs offer free counseling to help you understand your Medicare options. Trained counselors can explain what programs are available in your state and help you apply. You can find your local SHIP by visiting the SHIPs National Network website or calling 1-800-MEDICARE.

State Pharmaceutical Assistance Programs (SPAPs): Some states offer programs to help with prescription drug costs. These programs work with Medicare Part D to lower out-of-pocket expenses. To see if your state has an SPAP, visit your state’s health department website or ask a SHIP counselor.

Medicaid: If you qualify for both Medicare and Medicaid, you can get help with premiums, copays, and long-term care. Medicaid is a state-run program, and you can apply by contacting your state’s Medicaid office or visiting their website.

Programs for All-Inclusive Care for the Elderly (PACE): PACE helps seniors get the care they need while staying at home. It combines Medicare and Medicaid benefits for services like doctor visits and home care. To sign up, contact a local PACE organization through the medicare.gov website or your state’s Medicaid office.

There may be more programs available to you, so it’s important to check and see what help you can get. These programs can make a huge difference in your healthcare costs, so it’s worth checking if you’re eligible! Extra help could be a few steps away.

The Clover Health Editorial Team creates easy-to-understand Medicare content to help people learn about their coverage and options. Our articles are written and reviewed by licensed insurance experts, healthcare writers, and Clover's clinical specialists. Every article is checked for accuracy, clarity, and CMS compliance.

Sources:

Social Security Administration: ssa.gov

Medicare.gov: medicare.gov

New Jersey Division of Aging Services

SHIPs National Network