There are several programs that are available to Medicare beneficiaries to help save money on your prescription drug costs. These include Extra Help and State Pharmaceutical Assistance Programs (SPAPs). There are also resources available for union members through Union Plus.
Extra Help
Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. If your monthly income is up to $1,538 in 2018 ($2,078 for couples) and your assets are below specified limits, you may be eligible for Extra Help.
Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help, because certain types of income assets may not be counted. If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help.
The Extra Help program pays for your Medicare Part D premium up to a state-specific benchmark amount. It also lowers the costs of your prescription drugs. People with Extra Help have a monthly Special Enrollment Period (SEP) to enroll in a Part D plan or switch between plans in 2018. In 2019, Extra Help gives you an SEP to enroll in or switch Part D plans once per quarter in the first three quarters of the year (January through March, April through June, and July through September).
Finally, Extra Help eliminates any Part D late enrollment penalty (LEP) you may have if you delayed Part D enrollment. Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance.
If you do not have Medicaid, SSI, or an MSP, you can apply for Extra Help program through the Social Security Administration using either the print or online application (If you have Medicaid, SSI, or an MSP, you should automatically be enrolled). Be sure to complete the entire application and provide accurate information so you receive all the benefits for which you qualify.
State Pharmaceutical Assistance Programs (SPAPs)
State Pharmaceutical Assistance Programs (SPAPs) are programs offered by many states that can help residents pay for prescription drugs. Each program works differently.
States may coordinate their drug assistance programs with Part D. Some SPAPs require that you sign up for Part D coverage in order to qualify for assistance. In these cases, if a prescription drug is covered by both your SPAP and your Part D plan, both the amount you pay for your prescriptions plus the amount the SPAP pays will count toward the out-of-pocket maximum you have to pay before reaching catastrophic coverage.
Many SPAPs continue providing coverage during your Part D plan’s coverage gap. Your SPAP may also help pay for your Part D plan’s premium, deductible and copayments.
Certain states have qualified SPAPs. Qualified SPAPs provide a Special Enrollment Period (SEP) to allow you to enroll in or make changes to your Part D or Medicare Advantage coverage. Contact your State Health Insurance Assistance Program (SHIP) to find out if your state has an SPAP, if you may be eligible, and how to apply. If you do not know how to contact your SHIP, call 877-839-2675 or visit www.shiptacenter.org.
Assistance for Union Members
If you do not qualify for Extra Help or an SPAP, but want to save money on prescription drugs, check out the instant savings you or your family can enjoy through Union Plus. There is no cost to download and use the savings card as a union member at thousands of participating pharmacies nationwide.
If you need help in finding a Part D Medicare plan or have any questions about health plans available to you, please contact the Union Plus Retiree Health Insurance Program. The program has Medicare Insurance advisors who can help you compare plans and costs available to you among thousand nationwide. Call 1-888-719-0689 (TTY 711) Monday - Friday from 8 am to 8 pm EST to speak with a licensed insurance representative trained in dealing with union members or visit unionplusmedicare.org for more information.
*Much of this content is from the Medicare Rights Center.
Prescriptions don't always have to be expensive. Union members can get instant discounts on many medications through the Union Plus Prescription Discount program. As a Medicare beneficiary you can save on your medications even if you have limited income or no insurance. If you need assistance with a Medicare plan, please contact the licensed insurance advisors for the Union Plus Retiree Health Insurance Program at 888-719-0689 or at www.unionplusmedicare.com.