Cost-Saving Checklist:

Apply for Extra Help: You may qualify if you have limited income and assets. See the following page for details.

Learn about any State Pharmaceutical Assistance Programs (SPAPs) in your state:  Call your local State Health Insurance Assistance Program (SHIP) to find out whether your state has an SPAP, if you are eligible, and how to apply. Call 877-839-2675 or go to shiphelp.org to contact your SHIP.

Talk to your doctor: 

• Ask your doctor if a generic drug could work for you. Generic drugs are often less expensive and have lower cost-sharing than brand-name drugs.
•  Ask your doctor if they can provide you with samples of your medication. This is only a temporary solution.
•  Ask your doctor for assistance with appealing. If your drug is not covered or is covered on a high cost-sharing tier, you may be able to appeal.

Learn about any Patient Assistance Programs (PAPs) that could help you: Some drug manufacturers offer PAPs. Your doctor may have to apply for you, and eligibility varies based on the program.

Ask your pharmacist to waive your copay:  While they may not be able to do so routinely, your pharmacist may be able to waive copays on a case-by-case basis.

Look for charity programs that help pay drug costs:

• Hospitals may have a charity care policy; ask your hospital’s pharmacist.
• See if you are eligible for programs through charitable foundations like the Patient Access Network (PAN) Foundation, Good Days, CancerCare CoPayment Assistance Foundation, the HealthWell Foundation, and the National Organization for Rare Disorders (NORD)

 

The Extra Help Program:

You have:	Your eligibility requirements:	Your costs:
Medicare only	Income Limit[1] Individual: $1,903/month Couple: $2,575/month   Asset Limit[2] Individual: $17,600 Couple: $35,130	$0 premium and deductible $4.90 generic copay $12.15 brand-name copay
Medicare and an MSP	You are automatically enrolled in Extra Help
Medicare and Medicaid with or without an MSP	You are automatically enrolled in Extra Help	$0 premium[3] and deductible   Income above 100% FPL $4.90 generic copay $12.15 brand-name copay   Income below 100% FPL[4] $1.60 generic copay $4.80 brand-name copay

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[1] Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The above limits are based off the 2025 FPL. Limits are higher for each additional relative living with you for whom you are responsible. Income and asset limits on this chart are rounded to the nearest whole dollar. There is a $20 income disregard (factored into the income limits above) that the Social Security Administration automatically subtracts from your monthly unearned income (e.g., retirement income).

[2] Asset limits include $1,500 per person for burial expenses.

[3] You pay no premium if you have a basic Part D drug plan with a premium at or below the Extra Help premium limit for your area.

[4] You pay $0 copays if you are institutionalized or receive home and community-based services.

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