extra help
The main federal program that provides Part D cost assistance is Extra Help, and many people in other cost-saving programs can get Extra Help coverage without enrolling directly. That's because anyone with Medicaid, Medicare Savings Plan (MSP) or Supplemental Security Income (SSI) is automatically enrolled in Extra Help.
Even if you don't qualify for Medicaid, MSP or SSI, you may qualify for additional help. If you have Medicare Parts A and B, live in one of the 50 states (or DC), and meet the program's income and resource limits, you can apply for this program through the Social Security Administration.
Even if you don't qualify for Medicaid, MSP or SSI, you may qualify for additional help.
With Extra Help, you can reduce your prescription drug costs and pay no deductibles or premiums as long as you have a basic Part D plan with premiums at or below your state's “base” amount. If the premium for your Part D plan exceeds the baseline, you only pay the amount over the baseline. Premiums paid by Extra Help on your behalf still count toward your out-of-pocket maximum ($2,100 in 2026), after which you have no out-of-pocket expenses for the remainder of the year. The plan also eliminates late enrollment penalties and provides more special enrollment periods for changing standalone Part D plans.
Transition to additional help coverage
By 2026, there will be 88 baseline standalone Part D plans, one to four per state, that are premium-free for Extra Help beneficiaries. New Extra Help enrollees who do not select a Part D plan will automatically be enrolled in one of these baseline plans.
When you are new to Extra Help, your Part D coverage should start within two months of signing up for Extra Help. During this transition period, Medicare may enroll you in temporary drug coverage through the Limited Income Newly Eligible Transition Program (LI NET). The plan covers all Part D eligible drugs at any pharmacy and provides coverage retroactive to the start date of your Medicaid/SSI or Part D plan.
National Drug Assistance Program
Many states (including Washington, D.C.) and U.S. territories offer State Pharmaceutical Assistance Programs (SPAP) to help people pay for prescription drugs. Eligibility and benefits vary widely from state to state, and not all states require participants to be Medicare enrollees. SPAP, coordinated with Medicare Part D, can help you pay for prescription drug premiums, deductibles, and copays.
Because SPAPs vary widely from state to state, your State Health Insurance Assistance Plan (SHIP) is the best resource for understanding your state's eligibility, coverage, and cost guidelines.
Help from pharmacies, hospitals and other discount programs
Hospitals and healthcare providers can provide cost assistance on a case-by-case basis. Ask your doctor about less expensive generic medications that can replace your brand-name medication. As a short-term solution to a prescription drug supply gap or shortage, your doctor may also offer free samples of the drugs you prescribe.
Hospitals and healthcare providers can provide cost assistance on a case-by-case basis.
If you use a hospital pharmacy, ask if the hospital has a charity care program to help patients pay for their medications. You can also ask your pharmacist if your out-of-pocket cost can be waived. While this is often not possible without extra help, it may sometimes help you reduce direct costs.
Some pharmaceutical companies also offer discount programs on their medicines. You can check to see if your Part D drugs are part of the drug assistance program on the Medicare website, and you can track discounts on sites like NeedyMeds and GoodRX.
If you have questions or need help with the Part D Cost Assistance Program, you can contact your SHIP at shiphelp.org or call the Medicare Rights National Helpline at 800-333-4114.
