Understanding Medicare Drug Coverage: Keeping Rx Costs Down
Keeping Your Costs Down
Try these tips:
- Ask your doctor if generic drugs and/or lower-priced brand name drugs are available to treat your condition. There may be occasions when your in-network pharmacy has a lower price than that offered by your plan. Always ask your in-network pharmacy if you are paying the lowest price. If the pharmacy offers a lower price—even as a short-term “special”— you can purchase the drug directly from the pharmacy without using your plan card. But you must submit the receipt to your plan either to be reimbursed or to be counted toward your True Out-of-Pocket costs (TrOOP) in the coverage gap. You may also be able to lower your costs through other discount programs that use the same pharmacies as your drug plan. Use mail order to get a 90-day supply of your ongoing medications, if available; it might be cheaper.
- Pick the best drug plan for each person with Medicare in your family. Everyone’s drug needs are unique and everyone must have their own plan.
- Consider getting a drug plan that pays for drugs in the coverage gap if you have high drug costs. (This helps people whose drug costs are high enough to put them into the coverage gap, but not high enough to get them out of it. This type of plan may also help people who cannot afford to spend the out-of-pocket amount needed to reach catastrophic coverage or people who prefer to make the same copayments throughout the year.) If you land in the coverage gap and can’t afford to pay your plan’s full prices, consider finding out if the company that makes your drugs can help you under a patient assistance program, or ask your doctor for free samples.
- Medicare drug plans are required to offer Medication Therapy Management (MTM) programs to you if they expect that your total drug costs will be more than $4,000 a year. If you receive an invitation to participate in MTM programs, say “yes”—there is no charge to you. It could give you help in managing your medicines safely and save you money.
Where Can I Get Help with the Costs?
There are programs that pay for prescription drugs and other daily needs such as rent, food, or utilities. You can find out more about each of these programs or services by contacting each of the agencies listed.
The Social Security Administration or your state and local Medicaid offices can determine whether you are eligible for help with paying for Medicare Part D deductibles, premiums, and copays. This Extra Help greatly reduces drug costs for people who qualify. You must meet certain income and asset limits to qualify. You are encouraged to apply if your income and assets for 2007 are at or below:
- Single person: $15,315 Income, $11,710 Assets*
- Married Couple, $20,535 Income, $23,410 Assets*
* Includes stocks, bonds and savings. Your home, car, burial savings of up to $1,500 per person and other personal items are not considered assets for Medicare Part D Extra Help. These guidelines change and may affect eligibility each year.
Apply for Extra Help by calling Social Security at: 1-800-772-1213 (TTY 1-877-486-2048) or online at www.socialsecurity.gov/prescriptionhelp.
Drug Manufacturers’ Patient Assistance Programs--Many drug companies provide free or low-cost drugs to people who need them. Each manufacturer develops its own program and determines who can receive the benefit and how. People can enroll in a Medicare drug plan and still receive drugs through a drug manufacturer’s program as long as they still qualify. You won’t be able to receive the same drug from both programs. (You can use a drug manufacturer’s program to help pay for a drug you get from a Medicare drug plan while you’re in the coverage gap, but you can’t count this assistance towards your out-of-pocket expenses that would qualify you for catastrophic coverage.) Find more online at www.benefitscheckuprx.org or call your SHIP.
State Pharmacy Assistance Programs Over 20 states have programs that help people pay for prescription drugs. In many cases, these programs work with the Medicare drug benefit to offer even greater savings. Programs operate differently in each state. Some states limit participation to people with limited incomes and assets and others do not. To find out if there is a program in your state, contact your local Area Agency on Aging or State Health Insurance Assistance Program (go online to www.aarp.org/quicklink).
AARP Benefits QuickLINK is an online tool that helps people find programs and services in their communities and states. By completing some personal information and entering it into a confidential Web-based program, you will get a list of local programs for which you may be eligible. These important public benefits for older Americans and families with children help with many needs, such as paying rent, property taxes, heating bills, and food.
Benefits QuickLINK can help:
- Grandparents raising grandchildren find public benefits for families with children.
- 50+ parents find public benefits to support their children. Sons and daughters find public benefits in the state their parents live.
- Americans 50+ with limited incomes find and get applications for public benefits.
How does Benefits QuickLINK work?
- Go to www.aarp.org/quicklink.
- Answer a short list of questions, and
- Get fact sheets, applications, websites, and local agency contact information.
