Prescription Drug Coverage

Frequent Pitfalls

Not knowing all your options for prescription coverage

There are a number of ways that you can get help paying for prescription drugs if you don't have insurance or if or the coverage doesn’t pay for all of your costs.

The AIDS Drug Assistance Program (ADAP) helps those with HIV/AIDS, and drug companies also have Patient Assistance Programs (PAPs) for people who meet certain requirements.

For in-depth, free, personalized assistance to help you understand your options, call the Senior LinkAge Line® at 1-800-333-2433, or Chat with a Hub expert.

The best place to go to compare your options for Medicare Part D prescription coverage is on the website’s Prescription Drug Plan Finder.

NeedyMeds, Inc. provides information about Patient Assistance Programs (PAPs) to individuals, healthcare professionals, patient advocates, social service workers, and others. NeedyMeds, Inc. also helps with completing applications for PAPs.

PhRMA’s Medicine Assistance Tool (MAT) is a search engine for Patient Assistance Programs (PAPs) and the prescriptions that are covered.

RxAssist has a database of Patient Assistance Programs, with up-to-date information on more than 700 medications and how to get help from nearly 100 companies.

Refusing Medicare Part D prescription drug coverage if you get MA

If you are enrolled in Medicare and disability-based Medical Assistance (MA) without a spenddown, MA with a spenddown that you have met, or MA-EPD, you will automatically be enrolled in a Medicare Part D benchmark plan.

Being enrolled in MA or MA-EPD and Medicare automatically qualifies you for the Part D Low Income Subsidy. This means you won’t have to pay a premium for your Part D or any deductibles, including the donut hole. All you would pay for your prescription drugs is a copayment of $1.55 – $4.50 for generics or $4.60 – $11.20 for brand name prescriptions.

You don’t have to keep your Medicare Part D to keep your MA or MA-EPD, but if you decline Part D coverage, you won’t have any prescription drug coverage. MA cannot pay for your prescriptions if you decline Part D coverage.

MA with a spenddown is a bit different. Because you aren't enrolled in MA until you meet your spenddown, you aren't automatically assigned a Part D benchmark plan. Also, you are not automatically eligible for the Part D Low Income Subsidy until you meet your spenddown. Once you meet your spenddown for one month in the year, you automatically qualify for the Low Income Subsidy for the entire year. You’re automatically enrolled in a benchmark plan, if you have not already signed up for a plan on your own and otherwise qualify for automatic enrollment. Your only prescription costs would be copayments of $1.55 – $4.50 for generics and $4.60 – $11.20 for brand name prescription drugs.

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