Many older adults don’t realize they may qualify for assistance programs that can significantly reduce out-of-pocket expenses for essential medications.
From Medicare subsidies to nonprofit initiatives and manufacturer discounts, there are resources to help make medications more affordable.
We explore practical ways for seniors to access financial assistance for prescription drugs, ensuring they never have to choose between their health and their budget.
For Seniors, Paying for Prescription Drugs Can Be Difficult
When older adults cannot afford their prescriptions, they are less likely to follow the doctor’s instructions on dosage or frequency.
Social Security offers a program called “Extra Help With Medicare Prescription Drug Costs” to help people pay for prescription drugs.
It covers costs associated with a Medicare Part D prescription drug plan.
Through the program, seniors can significantly improve their health and quality of life by ensuring they receive the medications they need.
Extra Help is estimated to be worth about $5,300 annually for those who qualify. This program helps cover premiums, deductibles, and copayments for Medicare Part D prescription drug plans. – Medicare.gov
Did you know that over 3 million seniors qualify for the “extra help” program but aren’t enrolled?
Many low-income seniors are eligible for Extra Help but don’t enroll due to limited awareness. Outreach and simplified enrollment processes could bridge this gap, ensuring more beneficiaries can afford their medications.
We explain what the Extra Help program provides, who qualifies, and how to apply.
Major Update for 2025: The $2,000 Cap (and No More “Donut Hole”)
Starting in 2025, Medicare Part D rules have changed significantly to lower costs for seniors. The most important change is a new $2,000 annual cap on out-of-pocket expenses for covered prescription drugs.
Once an older adult’s out-of-pocket spending on covered drugs reaches $2,000, they will pay $0 for their covered prescriptions for the rest of the year.
Additionally, the confusing “Donut Hole” (Coverage Gap) has been eliminated. There is a standard deductible (up to $590), followed by an initial coverage phase that leads directly to the $2,000 cap. This simplifies the process and protects seniors from the burden of unlimited drug costs.
The Extra Help program helps people with limited income and resources lower or cut Part D costs. Medicare Part D provides drug coverage. The Extra Help program helps with the cost of prescription drugs, like deductibles and copays.
You can apply for Extra Help here.
VIDEO: How to Save on Prescription Medications
How to Qualify for the Extra Help Prescription Drug Program in 2025
Apply for the “Extra Help” Program
For seniors with limited income and resources, Social Security offers a program called Extra Help (Low-Income Subsidy). It is estimated to be worth over $5,300 per year.
New for 2024-2025:
The program has expanded. Previously, there were “full” and “partial” levels of help. Now, anyone who qualifies receives the full subsidy. This means no deductible, no premiums, and fixed low copays (e.g., $4.90 for generics / $12.15 for brand-name in 2025).
Who Qualifies in 2025?
You should apply if your loved one meets these approximate limits (2025 guidelines):
- Income: Up to $23,475 (individual) or $31,725 (married couple).
- Assets/Resources: Up to $17,600 (individual) or $35,130 (married couple).
Note: These limits can be higher if you live in Alaska/Hawaii or support other family members. Always apply, even if you are unsure – it’s free.
Prepare for the Extra Help Prescription Drug Program
Gather the following documents for you and your spouse:
- Bank statements and tax returns
- Individual Retirement Account (IRA) or 401(k) account balances
- Statements for pensions, Veterans’ benefits, annuities, and Railroad Retirement Board benefits
How to Apply
Call 1-800-MEDICARE (1-877-486-2048) or visit www.medicare.gov.
Even if someone doesn’t qualify for Extra Help now, they can reapply at any time if their income or resources change.
Pharmaceutical Industry Assistance Programs are Also Available
Use the Medicine Assistance Tool (MAT)
The biopharmaceutical industry offers a search engine called the Medicine Assistance Tool (MAT). This free tool replaces the old “Partnership for Prescription Assistance.”
It acts as a search engine to help you find patient assistance programs offered by drug manufacturers. By entering your older adult’s medications and basic information, MAT matches you with programs that may provide those medications at no cost or at a reduced price.
New Bonus Tip: Lower Costs for Insulin & Vaccines (Update)
Thanks to the Inflation Reduction Act, there are specific price caps you should know about:
- Insulin: Medicare Part D beneficiaries now pay no more than $35 per month for each covered insulin product.
- Vaccines: Recommended adult vaccines (such as Shingles, RSV, and Tetanus/Whooping Cough) are now $0 (free) for people with Medicare prescription drug coverage.
Final Thoughts on Paying for Prescription Drugs in 2025-2026
Securing financial assistance for prescription drugs is more than a logistical task; it’s a critical step in protecting your loved one’s health and economic stability. By exploring the options outlined here (from Medicare’s Extra Help and state Pharmaceutical Assistance Programs to manufacturer discounts and nonprofit aid), you transform an overwhelming challenge into a manageable action plan.
Remember, you don’t have to navigate this complex landscape alone. Taking the time to research and apply for these resources can dramatically reduce out-of-pocket costs, ensuring that necessary medications remain affordable and accessible. This proactive effort is a profound act of care, safeguarding not only their physical well-being but also the peace of mind that comes from knowing they can afford the treatments they need to thrive.
Start with one program today, and take a decisive step toward sustainable health and financial relief.
Recommended for you:
- Financial Help for Seniors: 2,500+ Federal, State, & Private Benefits Programs
- 5 Options for Medications Not Covered by Medicare
- 7 Ways for Seniors to Reduce the Cost of Prescription Drugs
About the Author
Connie is the founder of DailyCaring.com and was a hands-on caregiver for her grandmother for 20 years. (Grandma made it to 101 years old!) She knows how challenging, overwhelming, and all-consuming caring for an older adult can be. She also understands the importance of support, especially in the form of practical solutions, valuable resources, and self-care tips.
I received the so called “Extra Help” and it is still the same price with the deductibles even if they do cover it. It sucks so don’t fall for the avalanche of calls text and emails you receive. there is no help for seniors unless you are welfare
We’re sorry to hear that the Extra Help program didn’t provide enough financial assistance in your situation.
In case it’s helpful, you may be eligible for other benefits programs that could help with other expenses – Financial Help for Seniors: 2,500+ Federal, State, & Private Benefits Programs https://dailycaring.com/find-financial-help-for-seniors-federal-state-and-private-benefits-programs/
I’m a 68 year woman in need of an antibiotic called Tobi. I am one of the oldest survivors in Texas with Cystic Fibrosis. I cannot pay the deductible of 1000.00 to get this medicine. And I need it badly. I have a lung infection. I don’t know what to do. If you could point me in the right direction for help, I would greatly appreciate it. Thanks…. Bette Davis.
We’re so sorry to hear about this situation. Hopefully the Medicare Extra Help program described in the article above can offer some help.
You might also want to contact your doctor to find out if there are any programs from drug manufacturers that could help you get the medication you need.
We’ve got a few more articles with suggestions to get help paying for medication that might be helpful:
– 5 Options for Medications Not Covered by Medicare https://dailycaring.com/5-steps-to-take-when-medications-are-not-covered-by-medicare/
– 5 Ways to Afford Prescriptions in the Medicare Donut Hole https://dailycaring.com/5-ways-to-afford-prescriptions-in-the-medicare-donut-hole/
– 7 Ways for Seniors to Reduce the Cost of Prescription Drugs https://dailycaring.com/7-ways-to-save-money-on-prescription-drugs/
You might also want to contact your local Area Agency on Aging. They may be able to connect you to organizations that can help. More info here – Area Agency on Aging: Resources for Seniors https://dailycaring.com/area-agency-on-aging-resources-for-seniors/
If you are three dollars over the Extra Help income limit they will not help you.
We’re so sorry to hear about this 🙁
Wow what a great site to land on and so much great information.. I have bee6so frustrated on who or what to to help me these high copays on have.. Never have had such high copays even when I was working and now I see a light at the end of my tunnel
So glad our articles are helpful!
I am thankful for programs like these bc they do help alot & even more for others. If you dont think you qualify or are eligible, apply anyway bc usually you’re wrong & can get the help. It’s always better to apply for the help if you need it bc the worst thing they can say is no & no harm done, otherwise you may be missing out on help that you could get that would help & could possibly even make a world of difference. I care for my grandmother & I have learned that its there for anyone who needs it & even those that don’t know they need it. Sometimes it’s better to sign up for programs you qualify for even if you don’t think you need help bc that very well may be what saves you down the road & keeps you from ending up struggling to get by. You never know what the future holds & it’s not always what we plan that’s for sure. So it’s just smart to utilize these programs if we qualify,in order to be able to live better. My grandparents have been the type to not need help my whole life & were usually the ones trying to help others as much as they could but my granddad’s been gone for 9 yrs & I think I was prolly the only thing that went as planned since (I find legal papers a yr after moving in & he had named me as POA /executor). Honestly I don’t think they knew exactly how wide of a range of programs existed beyond snap & such. She thought she wouldn’t qualify. I’m not saying someone should go sign up for every single program put there but if I come across a program that I feel might benefit her in more than 1 way then it’s not gonna hurt to see if she qualifies. It’s my job as her caregiver to make her life better if I can & to do what benefits her any way I can. That should be what most caregivers want for their older adult. Make the remainder of the years they have left with us as enjoyable & stress-free as possible. So you do whatever to make it happen. Honestly that’s why programs have the criteria they go by so they know the ones that qualify need it. Sry for rattling on but point is theres alot of seniors out there that need help or could use some help & don’t realize there’s programs that are available for pretty much everything & like extra help is amazing but make sure u understand the terms & how it works bc I first thought it wasn’t worth it but after I found out that some ppl have a deductible to meet each yr before it drops to plan pricing. Soon as it’s met, her Rxs are $0 for several & under $5 with 1-2 under $15. It’s all dependent on what you meds u take so look it up before so u know what to expect. u gotta inform urself & if u don’t understand ask someone to help u. U get out what u put in at times too. 😌
Thanks for sharing your experience and tips with us!