If you have Extra Help, throughout the year you will pay either the Extra Help copayment or your plan’s copay for your prescription drugs. You always pay the lower cost between the two. Note that plan copays for prescriptions may change during the year, meaning at times the price for your prescription drugs may differ.
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Contact your local State Health Insurance Assistance Program
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Each state offers a State Health Insurance Assistance Program (SHIP), partly funded by the federal government, to give you free counseling and assistance. A SHIP counselor may be available by phone or in person.
Visit www.shiptacenter.org to find your local SHIP office.
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Example: Mr. S has Extra Help and a monthly income above $1,275, so his Extra Help copays are $4.50 for generics and $11.20 for brand-name drugs. However, his plan copay for his generics is $2.00. Mr. S will therefore pay the plan copay of $2.00 because it is cheaper than the Extra Help copay of $4.50.
If Mr. S had Extra Help and a monthly income below $1,275, his copays would be $1.55 for generics and $4.60 for brand-name drugs, making his generic Extra Help copay less costly than the plan copay of $2.00. This means that Mr. S would pay the Extra Help copay throughout the year.
Your out-of-pocket costs also change when you reach catastrophic coverage ($8,000 out of pocket in 2024). For all Part D beneficiaries, those who reach catastrophic coverage will pay nothing for covered drugs for the remainder of the calendar year.