For most aging adults, prescription medications are a line item on their household budget. With the Centers for Disease Control and Prevention reporting that about one in five older adults take at least five prescription drugs daily, it is no wonder that some seniors worry about finding the money they need to cover their next pharmacy bill. The average out-of-pocket prescription drug cost for adults aged 65 to 79 is about $456 annually. For those on a fixed budget, that expense is troubling. Fortunately, there are prescription assistance programs and other ways to offset the costs of prescription medications. Here are some avenues to explore when looking for how to get help with prescription costs.
Medicare
Medicare benefits can sometimes feel confusing, especially since there are so many parts with different names and costs. However, you can find some financial relief for prescriptions through Medicare.
Medicare prescription drug plans
Eligible seniors can enroll in Medicare drug plans, also called Medicare Part D, which add prescription coverage to original Medicare. Note that you have to opt into Part D coverage. To opt in, you must have Medicare Parts A and B.
Medicare Advantage plans with prescription drug coverage
You can also enroll in Medicare Part C (Medicare Advantage), which will give you Part D benefits to help cover your prescription medications in addition to Parts A and B coverage. You can enroll on the Medicare Plan Finder to get the process started.
Extra Help program
Medicare’s Extra Help program can help people with limited resources pay for prescription drugs. Some individuals are automatically enrolled, such as those with Medicaid benefits, those who have a Medicare Savings Program through their state, and those who receive Supplemental Security Insurance (SSI). Others can still qualify for Extra Help: If your income and resources don’t exceed the limits set by Medicare for the calendar year, you can apply.
Limited medication coverage through Medicare Part B
Medicare Part B also covers a small amount of prescription drugs when used under certain conditions, most often for drugs you wouldn’t normally administer yourself. For example, a new intravenous drug designed to slow symptoms of Alzheimer’s disease is covered, as are medications associated with the use of durable medical equipment like infusion pumps and some injectable osteoporosis drugs.
Part B might also cover some support with medication management via a home health care visiting nurse as long as it is prescribed by a physician and used on a short-term basis. Check with your physician to see if you might benefit from this service.
Medicaid
Medicaid, a program jointly run by the federal government and each state, can provide relief for eligible seniors looking to offset the costs of prescription medications. Medicaid coverage is based on financial need, and not all seniors who apply will be eligible.
Currently, federal law makes Medicaid pharmacy coverage optional for each state. However, all states provide coverage for outpatient prescription drugs to eligible individuals. For example, Illinois covers all prescription drugs and some over-the-counter ones filled at pharmacies that have signed a rebate agreement with the Centers for Medicare and Medicaid Services. Similarly, the state of Virginia covers prescription medications fully. Check your state’s Medicaid coverage to see how they can help with prescription costs.
Veterans assistance
For eligible Veterans, enrollment in the VA health care system is considered creditable coverage for Medicare Part D purposes. If you are eligible for Part D coverage, you can take advantage of the VA prescription drug coverage and be confident it is at least as good as the coverage offered under Part D. Only Veterans can receive this benefit, so dependents and family members need to find coverage elsewhere.
Contact your VA caseworker to learn more about your eligibility, as well as to find out how much your copays might be and if you must fill your prescriptions through VA-approved pharmacies or VA facilities.
Other state and county prescription assistance programs
Depending on your state, county, and city, you might also be eligible for additional funds to offset the costs of the medications you need. These prescription assistance programs are typically available due to grant funding, meaning benefits might be limited or not renewable each year.
In New Jersey, for example, older adults who meet age and income criteria and are enrolled in Medicare Part D can qualify for the Pharmaceutical Assistance to the Aged & Disabled (PAAD) program, significantly reducing prescription costs to as little as $5 per medication.
Other programs in the state of New Jersey are available to all residents regardless of their age or income. The New Jersey Drug Card program offers discounts to state residents through the participation of medication partners and pharmacies in the state.
You can find out which grants and programs are available in your area by contacting your state’s Division of Human Services or Office on Aging or looking on their websites. You can also contact your local Area Agency on Aging or your local senior services organization.
GoodRx coupons and prescription discounts
You don’t have to rely solely on benefits from federally funded programs to get further help with prescription costs. Apps and platforms like GoodRx allow users to search for the lowest prescription prices in the neighborhood and then direct them to that location. The platform states they can save consumers up to 80% on FDA-approved drugs, both brand-name and generic.
The GoodRx app offers free services to users, though there is an option to upgrade to a monthly plan for more benefits. For $9.99 per month, users can also get discounted telehealth visits and free home delivery plans for prescriptions.
Even better, you can use GoodRx regardless of your insurance status, so you might save even more money on your Medicare-covered prescriptions.
Store membership prescription discounts
You might already have corporate or store memberships that can help with prescription costs. Costco, for example, offers prescription medication discounts with a Costco membership. The discounts apply to Costco members, eligible dependents, and pets. You can find a participating pharmacy and show your Costco card to receive the discount.
You can get help with prescription costs
Reducing prescription medication’s monthly or annual costs can require a multifaceted approach, combining health care benefits with state-funded relief programs or apps that look for the lowest pricing available. A little research can help you find the best combination that works for your budget.
