Table of Contents:

  1. Make a Careful Selection
  2. Rethink Your Prescriptions
  3. Shop Around
  4. Get “Extra Help”
  5. Apply for a SPAP
  6. Apply for a PAP
  7. Research National and Local Charities
  8. How Much Could You Save?

Medicare isn’t free. While the federal health insurance program is intended to help seniors and disabled Americans manage their healthcare expenses, beneficiaries still face a number of charges. These charges are top of mind for many beneficiaries, especially where prescription drugs are concerned.

Since Medicare Part A and Part B do not cover the cost of prescription drugs, most beneficiaries select either a Medicare Advantage plan or a stand-alone Part D plan for support. Here are several strategies for getting the best coverage possible and reducing unnecessary costs.

Make a Careful Selection

A recent Kaiser Family Foundation (KFF) study found that drug costs can vary greatly from plan to plan. Assessing the top ten most-prescribed drugs, KFF found that some plans charge as much as 14 times more than others do for the same medication. That means saving on prescription drugs starts when you first enroll in either Medicare Advantage or Medicare Part D. Careful comparisons of co-pays, deductibles, and limits can help keep costs manageable from Day 1.

Rethink Your Prescriptions

It’s possible that some of your prescriptions are no longer necessary or that manufacturers have introduced new, more affordable options. A quick conversation with your healthcare provider may help you take inventory to eliminate redundancies and identify alternatives. During this conversation, beneficiaries should ask about purchasing 90-day supplies of key drugs rather than paying for monthly refills. In some cases, this change may immediately reduce costs.

Shop Around

Your choice of pharmacy may also have a big impact on monthly and annual drug costs. A convenient location or friendly staff might keep you coming back to the same place, but a quick review could help identify savings elsewhere. Beneficiaries might consider calling or visiting additional pharmacies to learn more about their options. It’s possible that small, independent pharmacies will offer better prices than their more well-known competitors.

Get “Extra Help”

Medicare beneficiaries with limited resources and income who need help with their drug costs may be eligible for the Extra Help program. In 2021, the following beneficiaries may qualify for partial or full Extra Help:

  • Individuals with:
    • Annual incomes below $19,140; and
    • Less than $14,790 in total resources
  • Married couples living together with:
    • A combined annual income below $25,860; and
    • Less than $29,250 in combined total resources

Medicare beneficiaries may apply to the Social Security Administration to see if they qualify.

Apply for a SPAP

State Pharmaceutical Assistance Programs (SPAPs) offer assistance to some low-income persons in certain parts of the country. Coverage, costs, and drug availability vary from state to state. Only some plans include enrollment fees, for example.

While fewer than half of states offer SPAPs, all 50 provide counseling services through their State Health Insurance Assistance Programs (SHIPs).

Apply for a PAP

Some beneficiaries can reduce costs by going directly to the source — the drug manufacturers. Many companies offer free and discounted drugs to qualifying individuals through Patient Assistance Programs (PAPs). Eligibility guidelines and benefits will vary, but all beneficiaries are encouraged to contact drug manufacturers to learn more. Additional information is available through Medicare’s provider database.

Research National and Local Charities

There are countless non-profit organizations dedicated to supporting Americans with certain conditions and disabilities. Many offer financial assistance that can be used to cover the costs of necessary drugs. Beneficiaries should start by researching their specific conditions and home regions to find the appropriate programs. The National Council on Aging offers a free tool to seniors to help research benefits programs in their area.

How Much Could You Save?

Remember, a little research can’t hurt. Even beneficiaries who are happy with their Medicare coverage could benefit from assessing and comparing their options. Contact a licensed sales agent at IHC Specialty Benefits, Inc. to get started today.

 

Information adapted from the Centers for Medicare & Medicaid Services

Understanding the Extra Help With Your Medicare Prescription Drug Plan, 2020. Social Security Administration.