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Financial Assistance for Medicare Drug Plan

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Low Income Subsidy

Congress set aside funds to help Medicare beneficiaries with low-incomes and assets receive financial assistance with their Part D plans. Known as ‘Extra Help' or the Low Income Subsidy, these funds are administered through the Social Security Administration, and an individual may qualify for a full or partial subsidy depending on income and assets. The Low Income Subsidy can help pay for beneficiary's drug premiums, co-pays, deductibles and costs through the Coverage Gap. Some Medicare beneficiaries qualify for the Low Income Subsidy automatically, and do not have to apply for it unless their income or assets increase above the eligibility level. Medicare beneficiaries who automatically qualify include:

  • people who are enrolled in Medicaid (sometimes called ‘dually eligible');
  • people who receive Supplemental Security Income (SSI); or
  • people in a Medicare Savings Program (MSP).

Although some qualify automatically, anyone may apply for this help through the Social Security Administration by calling 1-800-772-1213 or online. Don't make the common mistake of confusing the low-income subsidy application with enrollment in a Medicare prescription drug plan. They are separate processes run by entirely different entities.

To see if you might qualify for your state Medicaid program contact your state Medicaid office, or compare your income with the federal poverty level at Medicaid.gov. Your state Medicaid office also administers the Medicare Savings Programs, which are little-known assistance programs that help income-eligible Medicare beneficiaries pay for Medicare premiums, deductibles, and co-payments for part A and B.

State Patient Assistance Programs

Another possible source of assistance for Medicare beneficiaries with high drug costs are State Patient Assistance Programs, or S-PAPs. Unfortunately, not all states have S-PAPs, and some are limited to Medicare beneficiaries over age 65. Check with the Medicare Rights Center to learn if an S-PAP can help you.

It is always a good idea to keep copies of any application for any type of assistance you apply for, especially since it will take time to gather all of the documents you will need. Having a copy of your first application will save you time if you apply later, or to another program.

Patient Assistance Programs

The manufacturers of the different disease modifying drugs each have a Patient Assistant Program that may offer assistance for people on a Medicare Prescription Drug Plan, and who meet their income guidelines. These programs have changed as a result of the Medicare prescription drug program, and this information is subject to change. Call the appropriate Patient Assistance Program to find out if there is any financial assistance available for you.
 

Medicare Rights Center

Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare, and a collaborative partner of the National MS Society.

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Centers for Medicare and Medicaid Services

Medicare is a government entitlement program administered by Centers for Medicare and Medicaid Services (CMS). Visit Medicare’s official website.

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