Lowering Part D Costs: Federal, State, and Local Options

Extra Help

The main federal program that provides Part D cost assistance is Extra Help, and many people enrolled in other cost-saving programs receive Extra Help coverage without having to enroll directly. This is because anyone with Medicaid, a Medicare Savings Program (MSP), or Supplemental Security Income (SSI) is automatically enrolled into Extra Help.

Even if you do not meet the requirements for Medicaid, MSP, or SSI, you may be eligible for Extra Help. If you have Medicare Parts A and B, live in one of the 50 states (or D.C.), and meet the program’s income and resource limits, you can apply for the program through the Social Security Administration.

Even if you do not meet the requirements for Medicaid, MSP, or SSI, you may be eligible for Extra Help.

With Extra Help, you pay less for prescription drugs, and pay no deductibles or premiums, as long as you have a basic Part D plan whose premiums are at or below your state’s “benchmark” amount. If you enroll in a Part D plan whose premiums exceed the benchmark, you will only pay the amount over the benchmark. The premiums that Extra Help pays on your behalf still count toward your out-of-pocket maximum ($2,100 in 2026), after which you pay nothing out of pocket for the rest of the year. The program also eliminates late enrollment penalties and makes more Special Enrollment Periods available for changing stand-alone Part D plans.

Transitioning to Extra Help Coverage

In 2026, there are 88 benchmark stand-alone Part D plans, between one and four per state, that are premium-free for Extra Help beneficiaries. New enrollees to Extra Help who have not otherwise chosen a Part D plan are automatically enrolled into one of these benchmark plans.

When you are new to Extra Help, your Part D coverage should begin within two months of your Extra Help enrollment. During that transition period, Medicare may enroll you in temporary drug coverage through the Limited Income Newly Eligible Transition program (LI NET). This program covers all Part D–eligible drugs at any pharmacy and also provides retroactive coverage back to your Medicaid/SSI or Part D plan start date.

State Pharmaceutical Assistance Programs

Many states (including D.C.) and U.S. territories offer State Pharmaceutical Assistance Programs (SPAPs) to help people pay for prescription drugs. Eligibility and benefits vary widely by state, and not all require participants to be Medicare enrollees. SPAPs that coordinate with Medicare Part D may help you pay for prescription drug premiums, deductibles, and copayments.

Because SPAPs are very different from state to state, your State Health Insurance Assistance Program (SHIP) is the best resource to learn about your state’s guidelines on eligibility, coverage, and costs.

Assistance from Your Pharmacy, Hospital, and Other Discount Programs

Hospitals and medical providers may offer cost assistance on a case-by-case basis. Ask your doctor about less expensive generic drugs that may replace your brand-name drugs. As a short-term solution to gaps or shortages in your prescription drug supply, your doctor may also have free samples available for the drugs you have been prescribed.

Hospitals and medical providers may offer cost assistance on a case-by-case basis.

If you use a hospital pharmacy, ask if the hospital has a charity care program to help patients with drug costs. You may also ask your pharmacist if they can waive your copay. Though this is not routinely possible for people who don’t have Extra Help, it may occasionally help you reduce your immediate costs.

Certain pharmaceutical companies also offer discount programs for their drugs. You can check on the Medicare website if your Part D drug is part of a pharmaceutical assistance program, and you can also track discounts on websites like NeedyMeds and GoodRX.

If you have questions or need assistance with Part D cost assistance programs, you can contact your SHIP at shiphelp.org or call the Medicare Rights national helpline at 800-333-4114.