Prescription medications can be expensive, even with insurance. Here are programs and strategies to help people on disability benefits afford their medications.
In this article, we'll cover:
- Medicare Extra Help (Low Income Subsidy)
- Medicaid prescription coverage
- Patient assistance programs
- Other resources for medications
1. Medicare Extra Help (Low Income Subsidy)
What it is:
- Federal program to reduce Medicare Part D costs
- Lowers premiums, deductibles, and co-pays
- For people with limited income and resources
- Can save thousands per year
Who qualifies:
- On Medicare
- Limited income (varies by year)
- Limited resources (varies by year)
- Many SSDI recipients qualify
2026 limits (approximate):
- Income: Below ~$22,000 (single) / ~$30,000 (married)
- Resources: Below ~$17,000 (single) / ~$34,000 (married)
- Excludes home, car, burial funds
- Check current limits at ssa.gov
How it helps:
- Low or no monthly premium
- Low or no deductible
- Reduced co-pays (often $1-$11 per prescription)
- Eliminates coverage gap ("donut hole")
How to apply:
- Online at ssa.gov/extrahelp
- Call 1-800-772-1213
- Visit local Social Security office
- May qualify automatically if on SSI or Medicaid
Important: If you're on both SSI and Medicare, you may automatically qualify for Extra Help.
2. Medicaid Prescription Coverage
If you have Medicaid:
- Prescription drug coverage included
- Very low or no co-pays
- Extensive formulary
- May cover what Medicare doesn't
SSI and Medicaid:
- Most SSI recipients have Medicaid
- Automatic in most states
- Comprehensive drug coverage
- Little to no cost
Dual eligible:
- If you have both Medicare and Medicaid
- Medicaid may pay Medicare premiums
- Coordinates drug coverage
- Often best coverage available
What's covered:
- Most prescription medications
- Generic and brand name
- May require prior authorization for some
- Check your state's formulary
3. Patient Assistance Programs
What they are:
- Drug manufacturer programs
- Free or reduced-cost medications
- For people who can't afford them
- Brand-name drugs mostly
How to find them:
- NeedyMeds.org
- RxAssist.org
- Manufacturer websites
- Ask your doctor or pharmacist
Requirements typically:
- Proof of income
- No or insufficient insurance for drug
- U.S. residency
- Application required
How they work:
- Apply through manufacturer
- Provide income verification
- If approved, receive medications free or reduced cost
- Usually need to reapply annually
Examples:
- Pfizer's Patient Assistance
- Eli Lilly's Assistance Programs
- Johnson & Johnson's Patient Assistance
- Most major manufacturers have programs
4. Other Resources for Medications
State pharmaceutical programs:
- Many states have programs
- For seniors and disabled
- Search "[your state] pharmaceutical assistance"
- May help with costs Medicare doesn't cover
Discount cards and programs:
- GoodRx
- RxSaver
- SingleCare
- Free to use, can save 80%+
Generic alternatives:
- Ask doctor about generics
- Same medication, lower cost
- Often 80-90% less than brand
- Most medications have generics
Mail-order pharmacies:
- Often cheaper than retail
- 90-day supplies available
- Medicare Part D often includes
- Check your plan
Community resources:
- Free clinics
- Hospital charity programs
- Nonprofit organizations
- Local community action agencies
340B Drug Pricing Program:
- Some healthcare providers get reduced drug prices
- Pass savings to patients
- Federally qualified health centers
- Ask your healthcare provider
Tips for Managing Costs
Talk to your doctor:
- Explain cost concerns
- Ask about alternatives
- Samples may be available
- They want you to afford medication
Compare pharmacies:
- Prices vary significantly
- Use discount cards
- Check warehouse stores (Costco, Sam's)
- Independent pharmacies may negotiate
Review your Part D plan:
- Annual open enrollment
- Compare plans at medicare.gov
- Check if your drugs are covered
- Look for lower co-pays
How Purple Helps
- Track medication spending
- Budget for prescriptions
- Clear view of expenses
- Organize for assistance applications
- Manage your benefits