- Help Paying For Medication Copays
- Help With Prescription Drugs Copays
- Senior Help With Prescription Copays
- Foundations That Help With Copays
Extra Help recipients may see a reduction in their premium and deductible costs, and prescription copays are currently capped at $2.95 for generics and $7.40 for name-brand medications. Contact your state health department. Some states have copay assistance programs for low-income residents. The programs are usually open to people with specific. Ask about generic drugs—your doctor can tell you if you can take a generic drug instead of a brand.
It is important to maintain your health by taking medicines as prescribed. Mainers who cannot afford their medications should know that many public and private programs are prepared to provide free or low-cost prescription medicines to qualifying individuals. Tell your doctor if you can’t afford your medicines. Medical practices can then either help you apply to these programs themselves or refer you to one of Maine’s 15 hospital-based prescription assistance programs. Don’t put yourself at increased risk of infection by skipping the medicines you need to stay well.
Whether or not you have full health coverage, cost for prescriptions can be a serious concern. This section pulls together many programs that can help you pay for prescriptions. It does not list every resource for every issue, but does list the major areas.
Prescriptions programs that may help:
Medicare Savings Programs (MSP)
If you have Medicare but need help with prescription drug costs, the MSP can be a huge help. Depending on what level you qualify for, you could get help paying for Part B and Part D premiums, copays, coinsurance, and deductibles. For more information, please look at our flyer on the MSP.
DEL (Low Cost Drugs for the Elderly or Disabled)
Many people who are either disabled or 62 and older who do not qualify for MaineCare, can get this help. DEL provides an 80% discount off the cost of many commonly used drugs. Some people with high medication costs may be able to get coverage of less commonly used drugs. For people who already have Medicare, DEL does not take the place of Part D (Medicare prescription coverage). But, it may help to “wrap around” the Part D coverage in some cases. If you are eligible, it is good to apply for DEL.
What about “Estate Recovery?”
Estate Recovery does NOT apply to this program. Estate Recovery is when DHHS attempts to recover the cost of MaineCare services from an enrollee’s estate once they have passed away, if they have no surviving spouse or dependants, and if they had MaineCare when they were age 55 or over.
Asset guidelines
You may be able to get DEL help if
- You are single and have liquid assets less than $58,000,
- You are married and have liquid assets less than $87,000.
A liquid asset is cash or something easily turned into cash. It includes retirement but not real estate. Call us with any questions.
Income guidelines
| 2021 Monthly Income Guidelines for Drugs for the Elderly & Disabled (DEL) | |
|---|---|
| Family Size | Income |
| 1 | $1,986 |
| 2 | $2,686 |
| 3 | $3,386 |
| 4 | $4,086 |
| 5 | $4,786 |
| 6 | $5,486 |
| For each additional family member add: | $700 |
| Last updated on 01/19/2021 | ** more rules apply to income levels in this group (use disregards) |
Note: Some money can be “disregarded” or ignored when applying. So even if you are a little over income guidelines listed above, you should apply anyway. If you are unsure, call our HelpLine at 1-800-965-7476.
Maine Rx Plus
Maine Rx Plus provides a 60% discount off the cost of many commonly used generic drugs at many pharmacies across Maine (only 15% off brand-name drugs). There may be other programs that can help pay more of your drug costs, but if not, it is good to apply for MaineRx Plus.
What about “Estate Recovery?”
Estate Recovery does NOT apply to this program. Estate Recovery is when DHHS attempts to recover the cost of MaineCare services from an enrollee’s estate once they have passed away, if they have no surviving spouse or dependants, and if they had MaineCare when they were age 55 or over.
Asset guidelines
Assets do NOT count against you when applying for this program.
Income guidelines
| 2021 Monthly Income Guidelines for Maine Rx Plus | |
|---|---|
| Family Size | Income** |
| 1 | $3,759 |
| 2 | $5,082 |
| 3 | $6,405 |
| 4 | $7,731 |
| 5 | $9,054 |
| 6 | $10,378 |
| For each additional family member add: | $1,326 |
| Last updated on 01/19/2021 | **ineligible spouse disregard might apply |
Note: Some money can be “disregarded” or ignored when applying. So even if you are a little over income guidelines listed above, you should apply anyway. If you are unsure, call our HelpLine at 1-800-965-7476.
$4 Generics
Another way to save on prescriptions is by switching to generic. Generic medications are usually much cheaper than “brand name” drugs and may make it easier to find discounts. Many big retail store pharmacies have started providing many generic medications for only $4, regardless of your income or insurance status. Smaller, local pharmacies sometimes have generous discount programs as well. It’s a good idea to call the pharmacies nearest to you and ask about any discount programs that they offer!
Community-based Prescription Assistance Programs (CPAPs).
State prescription assistance programs like Maine Rx Plus can be helpful, but sometimes those programs don’t help enough. Community-based Prescription Assistance Programs (CPAPs) can search through their database to find other programs to help with the cost of medications. The CPAPs keep the latest information on a large number of drug company discount cards and discount programs for specific drugs. Staff can provide you with free information and help you to apply for discounts. For more information, see this flyer: Help with Prescriptions.
Free Samples
Sometimes Health Centers, Hospitals, and Free Clinics are given free samples of certain medications that they can share with their patients. This assistance is usually not a long-term solution, but can definitely help! Whenever you are prescribed a medication, it never hurts to ask if there are free samples available.
Safely Ordering Drugs from Canada
For information about mail-ordering drugs from Canada, visit the Health Canada website to learn how to protect yourself from fraudulent companies.
Help with Private Insurance Co-pays
Even if you have insurance coverage, cost may still be an issue. Some people may be able to get help paying their co-pays if they meet certain income and medical guidelines. For more information visit the Patient Advocate Foundation’s Co-pay Relief website. Call the HelpLine at 1-800-965-7476 for more details.
TRICARE
Military retirees, and some family members or former spouses age 65 and older may be eligible for two programs provided by the Department of Defense: TRICARE for Life and the TRICARE Senior Pharmacy Program. For more information and complete eligibility requirements for the TRICARE for Life and TRICARE Senior Pharmacy Program, contact Sierra Military Health Services (the Northeast Regional Contractor) toll free at 1-888-999-5195.
Veterans Benefits
CHAMPVA is a health care benefits program through the Department of Veterans Affairs (VA). For the spouse or widow(er) and for the children of a veteran who: is rated permanently and totally disabled due to a service-connected disability; was rated permanently and totally disabled due to a service-connected condition at the time of death; died of a service-connected disability; died on active duty and the dependents are not otherwise eligible for DoD TRICARE benefits. Under CHAMPVA, VA shares the cost of covered health care services and supplies with eligible beneficiaries.
HIV/AIDS Assistance
If you have been diagnosed with HIV/AIDS and you are a resident of Maine, you could get assistance from the State of Maine to get HIV-related medications free of charge. The Aids Drug Assistance Program (ADAP) is a program of the Maine Center for Disease Control and Prevention (Maine CDC), HIV/STD Division. If you are interested in ADAP contact the Maine CDC at (207) 287-2899. You can also contact one of the HIV/AIDS organizations in the state or contact the AIDS Hotline at 1-800-851-2437.
Help Paying For Medication Copays
Hospital Programs
Many hospitals in Maine provide free or reduced-cost emergency services to people at certain income levels. Some hospitals go above and beyond just the emergency services and will also provide help with medications and other services. For more information, check out our page on Hospital Free Care, or call the HelpLine at 1-800-965-7476.
MedAccess
MedAccess works with individuals and health care providers to identify ways patients can save money on prescription medications. The free program, administered by MaineHealth, helps patients and health care providers evaluate options such as pharmaceutical companies’ patient assistance programs, low-cost generic programs, and Medicare Part D and state and local prescription programs that can help save on prescription medication costs. For more information, see the MaineHealth MedAccess Program. MedAccess is part of the MaineHealth CarePartners Program.
Drug Safety, Effectiveness, and Cost
Consumer Reports Health Best Buy Drugs™ offers free, trusted educational resources to help patients access the safest, most effective, and most affordable prescription drugs available. This resource is a grant-funded project providing independent, evidence-based reports on prescription drugs based on research conducted at the Drug Effectiveness Review Project, headquartered at the Oregon Health & Science University. Consumer Reports Health “translates” findings into consumer-friendly reports that are available for free. These reports identify drugs that are as effective and safe as others in its class but often available at a lower cost, as well as provide information about the underlying condition. These recommended drugs are often generic drugs, but in the case that a brand-name drug is superior to a lower-cost drug in safety or efficacy, it is recommended regardless of price. The reports are freely accessible at Consumer Reports Best Buy Drugs, and also available for free in magazine format.
Help With Prescription Drugs Copays
AARP’s Drug Savings Tool provides the Consumer Reports Health Best Buy Drugs™ information in a different format to further help people learn about and pay less for the prescription drugs. Visit the tool at AARP’s Drug Savings Tool.
Seniors pay a big price for the prescription medications they need to stay healthy, even with Medicare prescription drug coverage. Kaiser Family Foundation research shows the cost of copays for prescriptions often totals thousands of dollars a year for seniors. For some, the financial burden leads to skipping doses, cutting pills in half to make the medication last longer, or simply going without. If you’re having trouble affording your prescriptions, here are some possible sources of help.
Talk to your doctor about drug cost
It may feel awkward to discuss money with your doctors, but they need to know if you can’t fill your prescriptions because of the cost. Some doctors keep samples from drug company representatives to give to patients who need a little help covering the cost in the short run. Your doctors may also know about coupons and patient assistance programs (more about PAPs below). They may also be able to prescribe a lower-cost generic drug, although generic drug prices are rising, too.
Ask your pharmacist for advice on paying for medication
Pharmacists see the sticker shock their customers face at the register and are usually eager to help. Ask your pharmacist if he or she knows about coupons to help with a one-time prescription or PAPs for medications you need long-term. Some pharmacy chains and grocery stores offer $4 deals on 30-day supplies of common generic drugs. Others have their own prescription discount card programs that offer much lower drug prices to cardholders.
Apply for Medicare’s Extra Help program
If you’re a Medicare beneficiary with a low income and few assets, you may qualify for the Extra Help program even if you’re not eligible for Medicaid or SSI. Extra Help’s upper income limit for a single senior in 2016 is $17,820, with a maximum of $13,640 in assets (including savings, stocks, and bonds). Extra Help recipients may see a reduction in their premium and deductible costs, and prescription copays are currently capped at $2.95 for generics and $7.40 for name-brand medications.
Contact your state health department
Some states have copay assistance programs for low-income residents. The programs are usually open to people with specific illnesses, and availability varies from state to state. Ask your state health department or check the Medicare Rights Center’s national list of state pharmaceutical assistance programs.
Look for prescription assistance programs (PAPs)
Senior Help With Prescription Copays
The Partnership for Prescription Assistance is a free source of information about drug-company prescription insurance programs. Just enter the name of the drug you need and you’ll see what, if any, PAP can help you cover the cost. You can also search for affordable healthcare clinics in your area.
Connect with non-profit prescription help programs
Many doctors, public health experts, and policymakers have developed non-profit programs to help people pay for their medication. You can search with these three resources:
Foundations That Help With Copays
- The Medicare Rights Center’s charity copay help list
- The Patient Advocate Foundation’s Co-Pay Relief website
- Needymeds.org, a clearinghouse for patient information on affording prescription drugs
You may also be able to free up more money for your medication by getting help with other expenses. Check out these other financial resources for seniors.
Casey Kelly-Barton
Casey Kelly-Barton is an Austin-based freelance writer whose childhood was made awesome by her grandmothers, great-grandmother, great-aunts and -uncles, and their friends.
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