Drug Prescription Programs for Medicare Part D

Medicare is the federally administered health care program for elderly and disabled Americans. Part D offers prescription drug coverage. These drug plans are available exclusively through private drug insurance companies, and thousands are available nationwide. Since Part D was launched, state and federal agencies and private companies have created programs to help consumers better handle some of the costs of the Medicare prescription drug plan.

Extra Help

• Extra Help assists those who qualify pay for their Part D costs. The Social Security Administration administers this program, and eligibility is based on income (in 2010, monthly income including any Social Security payments must be below $1,354 if single or $1,822 if married). Some income and assets are excluded, however, so Social Security encourages those who are above the limits to apply. The Social Security website cites that the average Part D savings is more than $3,900 per year.

  Based on your income, there are two levels of Extra Help---full and partial. Those with full Extra Help pay no premiums, deductibles or co-payments. Partial Extra Help enrollees pay premiums on a sliding scale, reduced deductibles and discounted co-payments. Those in the Extra Help program also have no coverage gap, also known as the "doughnut hole," which is the point when Part D beneficiaries must pay 100 percent of their drug costs.

State Pharmaceutical Assistance Programs

• State Pharmaceutical Assistance Programs are often designed specifically to work with Part D. Some states even offer assistance programs that work as a Medicare beneficiary's creditable Part D drug coverage.

  Though these programs vary from state to state, and not all states offer them, they often cover an enrollee's premiums, deductibles and co-payments. In many cases they will offer some form of coverage during the Part D coverage gap. Any money that a state assistance program certified by the Centers for Medicare and Medicaid pays toward an enrollee's prescription drugs also counts toward the out-of-pocket limits that he must reach to get out of the coverage gap. Drug costs are markedly lower once the patient is out of the coverage gap.

  State assistance programs are often easier to qualify for because the income limits are higher than for Extra Help. For example, the Elderly Pharmaceutical Insurance Coverage in New York has income limits up to $35,000 a year.

Patient Assistance Programs

• Several pharmaceutical companies have set up Part D Patient Assistance Programs for cases in which a Part D plan refuses to cover a drug, a patient cannot afford an expensive co-payment or a patient needs help during the coverage gap. Most of these programs are drug-specific, meaning you apply directly to the pharmaceutical company to get assistance with paying for a specific drug. Many websites, such as RxAssist and NeedyMeds, have databases of these programs.

  Any assistance received from such a program will count toward the out-of-pocket expenses needed to get out of the Part D coverage gap.