Medicare: Your GoodRx guide
Learn the ins and outs of Medicare with our comprehensive guide that covers eligibility, coverage, costs, and more.
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Common Medicare glossary terms
The Medicare Annual Notice of Change (ANOC) is a letter for people enrolled in Medicare Advantage plans and anyone with Medicare Part D prescription coverage. People with Medicare Advantage or original Medicare (Part A and/or Part B) can have Part D plans. The ANOC informs enrollees about any changes to their benefits for the coming coverage year. By law, Medicare Advantage and Part D plans must send the ANOC to enrollees by September 30 — which is before the annual Medicare open enrollment period of October 15 to December 7. Even if you have the same plan, your benefits could change year to year.
A premium is the cost of having a health insurance plan and is usually paid monthly. Medicare enrollees may pay several premiums. Most people don’t pay anything for Part A hospital insurance, but some people do depending on how long they worked and paid taxes. For outpatient and preventive coverage, the Part B standard premium is $185 a month in 2025, but people with higher incomes pay more. Your premium for Medicare Advantage plans will vary, but even so-called “zero premium” plans require you to pay your Part B premium. Part D premiums range in price, but the average is about $47 a month in 2025. If you have original Medicare and a Medigap supplement plan, you have an additional premium for that coverage.
A deductible is the amount you pay out of pocket before your Medicare plan begins cost-sharing. In 2025, the Part A deductible is $1,676 per benefit period. The Part B deductible is $257 for the year, but you can access certain preventive care — including some vaccines — without meeting your deductible. Medicare Advantage deductibles vary and your Part D deductible can’t exceed $590 in 2025.
Original Medicare has no annual out-of-pocket maximum. Medicare Advantage plans have out-of-pocket limits. In 2025, they are $9,350 for in-network covered services and $14,000 for in-network and out-of-network covered services combined.
Starting January 1, 2025, anyone with Part D coverage had the option to use the Medicare Prescription Payment Plan for their out-of-pocket medication costs instead of paying upfront at the pharmacy. This plan doesn’t provide savings, but allows you to spread prescription costs — including your deductible — over the year. Making payments can be particularly helpful for people who may skip or delay picking up prescriptions because of high costs early in the year. Also in 2025, the Part D out-of-pocket limit dropped to $2,000.
After a Medicare enrollee meets the Part D deductible (if the plan has one), the health insurance begins cost sharing. The initial coverage phase means you pay coinsurance or a copay for covered prescriptions.
When you reach the $2,000 out-of-pocket maximum, your Part D plan pays for 100% of covered medications for the rest of the year.
How to save on drugs with Medicare
Medicare Part D is the part of Medicare that helps cover prescription medications, including both brand name and generic. It also includes coverage for certain vaccines that aren’t covered by Part B, as well as some medical supplies.
Even with Medicare Part D coverage, you may still have out-of-pocket costs such as premiums, deductibles, copayments, and coinsurance. As of 2025, Medicare Part D plans include a $2,000 annual out-of-pocket cap. Once you reach this limit, your plan covers the full cost of your covered medications for the rest of the year.
Still, there are several ways to reduce your prescription medication cost. From GoodRx coupons to patient assistance programs, here are ways you can save money on the medications you need.
1. See if you qualify for Medicare’s Extra Help program
The Medicare Extra Help/Low-Income Subsidy program is a federally funded program for people covered under a Medicare Part D plan. It helps reduce enrollees’ out-of-pocket costs by limiting their deductibles and copays. To qualify, your income and assets fall below a certain limit.
If you’re eligible, you may receive:
No monthly premiums for Medicare Part D
No Medicare Part D deductible
Low copays for prescription medications
2. Use GoodRx coupons
You can’t combine GoodRx coupons with Medicare, but you can choose to use a coupon instead of your insurance if it results in a lower price.
Here’s how to download a GoodRx coupon:
Go to the GoodRx website, or download the GoodRx app on your phone.
Search for your prescription medication.
Enter your prescribed dose and quantity, then set your location.
Compare prices across different pharmacies in your area.
Click “Find the lowest prices” or press “Enter.”
You can have the coupon sent by text or email, or print it out.
To apply the discount, show the coupon at the pharmacy when you fill your prescription. Ideally, this is done at drop-off before the prescription is filled.
3. Consider the Medicare Prescription Payment Plan
The Medicare Prescription Payment Plan is a new program that can help make paying for medications more manageable. It’s open to anyone with a standalone Part D plan or those with Medicare Advantage plans that offer prescription medication coverage.
There is no cost to participate in the Medicare Prescription Payment Plan and participation is voluntary. Instead of paying for the total cost of your medications up front at the pharmacy, the payment plan allows you to spread the cost into smaller payments during the year. If you join, you will continue to pay your premium every month as well as an additional monthly amount on your payment plan. It’s a good idea to review how the Medicare Prescription Payment Plan works to determine if it’s right for you.
4. Compare Part D plans during open enrollment
Medicare open enrollment, which takes place every year from October 15 to December 7, is your chance to switch plans if another option offers better prescription medication coverage or lower costs. Plan costs and coverage details can change each year, so it’s important to review your options.
Here are some steps to help you compare plans:
Make a list of all your medications and what dosages you take.
Visit Medicare’s plan finder tool.
Enter the names of your prescription medications to see which plans offer the best coverage.
Look at premiums, deductibles, and medication costs for each plan. Plans usually change their formularies, premiums, and copays annually.
Check if your preferred pharmacy is in each plan's network.
5. Get a 90-day supply
Opting for a 90-day supply instead of a monthly refill of your medication might help reduce your long-term out-of-pocket costs. Many insurance plans offer lower copays or bulk pricing for 3-month prescriptions.
If your medication is covered under your plan, see if your insurer’s mail-order or specialty pharmacy provides savings on a 90-day supply. If they do, ask your prescriber to write a prescription for a 90-day quantity to take advantage of these potential savings.
6. Ask about the generic version of your medication
Some medications have a generic version, and they generally cost less than the brand-name prescriptions. Generic medications are just as safe and effective as brand-name medications, so it’s an option worth considering to reduce your cost. Ask your prescriber about switching to a generic version of your medication to save money.
7. Consider lower-cost alternative medications
There may be other medications that help manage your condition, and they may cost less. If your medication is costly or not covered by your insurance, talk to your prescriber about lower-cost alternatives that might be a good option for you. Alternatives might have better insurance coverage or lower costs.
8. Learn more about patient assistance programs
Patient assistance programs (PAPs) offer free or low-cost medications to uninsured and low-income consumers. These programs, which primarily offer savings on brand-name medications, are usually run by private pharmaceutical companies or nonprofit organizations. You must meet certain qualifications and complete paperwork to receive savings from PAPs. However, some PAPs exclude Medicare recipients, so it’s important to review the program’s rules and requirements carefully.
9. Check state-funded resources
Depending on where you live, your state may offer programs to help you navigate prescription medication costs. A good place to start is your local Department of Aging. This U.S. Department of Health and Human Services office can help you find the best Medicare plan for the coverage you need.
Some states even have their own cost-saving programs for older adults. For example, Pennsylvania runs PACE and PACENET. These programs help eligible residents get prescription medications at reduced costs.
Alternatively, you can find out if your state has a State Pharmaceutical Assistance Program by using Medicare’s search tool. These programs are state-run and help qualifying residents pay for prescription medications.
10. Use a health savings account to pay for prescription medications
Although you can’t contribute to a health savings account (HSA) after enrolling in Medicare, you can still use any remaining funds in your account to pay for qualified medical expenses. An HSA allows you to use tax-free dollars to pay for eligible prescription medications. The money in your account does not expire so you can use your funds at any time to reduce your out-of-pocket medication costs.
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Frequently asked questions about Evrysdi
No. Evrysdi is only available as a brand-name medication.
No, Evrysdi isn't a gene therapy. It's a type of medication called an RNA splicing modifier. Gene therapy and RNA splicing modifiers both use genetic material to treat genetic conditions. But they work in different ways. Gene therapy gives your body a new working gene to replace the one that's missing or not working. Evrysdi doesn't do that. Instead, it makes changes to the faulty gene that people with spinal muscular atrophy (SMA) have. These changes help you body make a protein called survival motor neuron (SMN) that works correctly. This can help muscles work better in people with SMA.
In studies, people 2 to 25 years old with type 2 or 3 spinal muscular atrophy (SMA) got better after taking Evrysdi for a year. They had better movement skills, motor function, and arm strength. In another study, Evrysdi helped with muscle strength in babies with type 1 SMA. After a year of treatment, about 30% of babies could sit up without help for at least 5 seconds and almost 90% could breathe on their own. After another year of treatment, 60% could sit up without help for at least 5 seconds. If you have questions about how well Evrysdi is working, ask your prescriber.
In studies, the levels of working SMN protein needed for nerve and muscle function went up within 4 weeks of taking Evrysdi. But how fast your muscles get stronger can be different for everyone. In general, it can depend on your age, the type of SMA you have, and your symptoms. In studies, people 2 to 25 years with Type 2 or 3 SMA had better motor strength within 4 months of treatment. But it took 8 to 12 months to get the most help from the medication. Follow up with your prescriber about your motor skills and muscle strength. If you have questions about how long Evrysdi is taking to help, ask your prescriber.
Both Evrysdi and Spinraza (nusinersen) can help treat all types of spinal muscular atrophy (SMA) in adults and children. They work in different ways to get the levels of SMN protein in the body go up. , but they do so in different ways. The medications also differ in how you take them. Evrysdi is taken by mouth once a day. But Spinraza is as an injection into the spine given by a healthcare professional every 4 months (after some starter doses). The side effects slightly differ as well. Evrysdi can cause diarrhea and rash. But Spinraza has a risk of more serious side effects like kidney and bleeding. Talk to your prescriber to learn about how these medications compare and which is right for you.
Evrysdi and Zolgensma (onasemnogene abeparvovec) work in different ways to treat spinal muscular atrophy (SMA). They're also approved for people of different ages. Evrysdi is for people of all ages. But Zolgensma is only for children younger than 2. You also take the medications in different ways. Evrysdi is taken by mouth once a day. Zolgensma is given as an infusion into your vein as a single dose. And the side effects can be different. Evrysdi can cause diarrhea and rash. On the other hand, Zolgensma has risks like infusion reactions and liver damage. Talk to your prescriber to learn more about comparing the two medications and see which is right for you.
If you're pregnant or thinking of getting pregnant, talk to your prescriber. They can explain the risks of taking Evrysdi. It's not clear if it's safe to take while pregnant. But in animal studies, doses that were 2- to 4-times higher than the typical dose harmed babies. If you get pregnant while taking Evrysdi, tell your prescriber right away. They can talk to you about joining the Evrysdi Pregnancy Registry. This registry helps researchers learn more about how safe the medication is during pregnancy. You can visit the registry's website or call 1-833-760-1098 for more information.