Advertisement
Are Your Medicare Prescription Costs Too High?
If you are on Medicare and find yourself skipping doses, cutting pills in half, or choosing between groceries and medication, you are not alone. Millions of Americans over 55 face this exact struggle every month. But here is something important to know: there is a federal program called Medicare Part D Extra Help that could dramatically lower what you pay for prescription drugs — and many people who qualify never apply simply because they do not know it exists.
This article walks you through five clear signs that your Medicare prescription costs may be too high and that Extra Help might be exactly what you need. If even one of these signs sounds familiar, it is worth taking a closer look.
What Is Medicare Part D Extra Help?
Medicare Part D Extra Help — sometimes called the Low Income Subsidy (LIS) — is a federal program run through Social Security. It is designed to help Medicare recipients with limited income and resources cover the costs associated with their Part D prescription drug plan.
Here is what the program can help cover:
- Part D monthly premiums
- Annual deductibles
- Prescription copays and coinsurance
Depending on your situation, your copays could drop to as little as $0 to $10 per prescription. The program can save eligible individuals up to $5,300 per year on drug costs. That is real money that can make a significant difference in your day-to-day life.
Sign #1: You Are Skipping or Rationing Your Medications
This is perhaps the most serious warning sign. If you have ever taken half a dose to make your pills last longer, skipped refills to save money, or simply stopped taking a medication because of cost, your prescription expenses are already too high — and your health may be suffering as a result.
Extra Help exists precisely for situations like this. No one should have to choose between their health and their finances. If cost is getting in the way of taking medications your doctor has prescribed, this program was designed with you in mind.
Sign #2: Your Monthly Income Is Limited
Extra Help is specifically for Medicare recipients with limited income and resources. While the exact income and asset thresholds are updated each year and can vary, they are generally set high enough to include many people who think of themselves as middle-income — not just those in poverty.
A common misconception is that you have to be very low-income to qualify. That is not necessarily true. Even if you own a home, have a modest retirement account, or receive Social Security benefits, you may still be eligible. The Social Security Administration reviews each application individually, so it is always worth checking rather than assuming you do not qualify.
Medicare Prescription Costs Too High Even on a Fixed Income?
If you are living primarily on Social Security, a pension, or retirement savings, and prescription costs are eating into your monthly budget, that is a strong signal to apply. Fixed-income households are exactly who this program is built to support.
Sign #3: You Are Not Getting Extra Help Automatically
Some people are automatically enrolled in Extra Help — for example, those who receive Medicaid or Supplemental Security Income (SSI). But many eligible individuals are not automatically enrolled and must apply on their own.
If you are not sure whether you have Extra Help already, check your Medicare plan documents or call 1-800-MEDICARE. If you are not enrolled and you have limited income, you could be leaving hundreds or even thousands of dollars on the table every single year.
Sign #4: You Take Multiple Medications Each Month
The more prescriptions you fill each month, the more Extra Help can save you. Even if each individual copay seems manageable on its own, the costs add up quickly when you are managing multiple conditions — which is common for adults over 55.
Consider this: if you take five medications per month and each one costs $30 to $50 at the pharmacy, that is $150 to $250 out of pocket every single month. With Extra Help, those same prescriptions could cost you just a few dollars each — or nothing at all, depending on your level of eligibility.
Many seniors manage chronic conditions like diabetes, high blood pressure, heart disease, or arthritis — all of which often require ongoing prescriptions. Extra Help can make managing those conditions far more affordable.
Sign #5: You Have Not Reviewed Your Eligibility Recently
Your Medicare Prescription Costs Too High Could Be a Temporary Problem
Life circumstances change. Maybe your income dropped after retirement. Maybe a spouse passed away and household income decreased. Maybe your prescription needs have grown over the past few years. Even if you applied for Extra Help in the past and were denied, your situation today may be different — and it is worth reapplying.
Extra Help eligibility is based on your current income and resources, not what they were years ago. If anything has changed financially, a fresh application could result in a very different outcome.
How to Apply for Medicare Part D Extra Help
Applying is straightforward and free. Here are your options:
- Online: Visit ssa.gov to apply through the Social Security Administration website
- By phone: Call Social Security at 1-800-772-1213 (TTY: 1-800-325-0778) — representatives are available Monday through Friday
- In person: Visit your local Social Security office
- Through your State Medicaid office: Some states also accept applications directly
The application asks for basic information about your income, assets, and Medicare coverage. There is no cost to apply, and you will not be penalized for applying even if you are not approved.
Do Not Wait — Take Action Today
If your Medicare prescription costs are too high and even one of the five signs above sounds like your situation, there is no reason to wait. Extra Help is a legitimate federal benefit that exists specifically for people in your position. Every month you delay is a month you could have been saving money on your medications.
The first step is simple: visit ssa.gov or call 1-800-772-1213 to check your eligibility and start your application. It takes only a short time to complete, and the financial relief it provides could be substantial.
You worked hard. You deserve access to every benefit available to you. Do not leave money on the table.
Advertisement
