Medicare can be a complex subject. We've tried to answer the most common questions about saving money on prescription drugs in conjunction with your Medicare account.
Medicare Part D and Advantage programs are important tools for helping seniors save money. These programs enable you to find significant discounts versus the “cash price” you'd otherwise have to pay at the pharmacy.
GoodRx offers 3 ways to help seniors who have Medicare Part D or Advantage:
Know the price of a drug before you go to the pharmacy
The cost of your prescriptions can change very frequently. Drug prices change, formularies change, co-pays change, and prices may vary by pharmacy depending on the type of coverage you have. It has been very hard for a senior to “know before you go” so that you can better understand your healthcare costs.
Learn about cost-saving alternatives
Once you can easily access prices, there are many ways you can save money on your prescriptions. Is your drug on formulary? Have you priced generic alternatives? Have you looked up the prices of alternative drugs which treat the same condition but cost less? Have you looked at purchasing a higher dosage pill or a greater quantity, which may cost less on a per-dose basis? Have you looked at mail order pharmacy options? All of these options can be easily compared by simply looking up a drug on GoodRx, and they can generate real savings.
Can you beat your Medicare drug insurance co-pay?
Medicare's Part D and Advantage programs will bring down your drug costs, but they do not always offer the lowest prices. Many chain pharmacies offer membership clubs with low-cost generics. There are a variety of coupons and discounts available on GoodRx (for free) which can provide lower prices than your co-pay. If your drug is not on your formulary, Medicare will provide limited coverage and you may want to explore the other options provided on GoodRx to bring down the cost of these drugs.
Adding your Part D or Advantage plan is very easy. You can view and compare Medicare prices on each drug page. If you don't already have a My Rx account, you can also register to save your plan and prescription information. All you need to register is an email address.
Whether you have a My Rx account or not, here's how you add your plan:
Search for your prescription in your ZIP code on GoodRx.
Look for the Medicare tab on the left of the page (right between Prices and Savings Tips).
Clicking on the tab will take you to a page with more information on typical coverage for your prescription.
On the Medicare page, click either blue button (See My Plan's Prices or Select Your Plan) to see prices and Savings specific to your plan. This will open up a box where you can select your plan.
Make sure your ZIP code has been entered and is correct—some plans are only available in certain areas!
Do you have Medicare Part D or Medicare Advantage? Choose the appropriate box. If you're not sure, select both boxes.
Choose your plan from the drop-down list. We've provided your monthly premium to help you figure out which plan is yours.
If you don't see your plan, try going back and checking both the Part D and Advantage boxes to see a complete list of plans available in your area.
If you know your current stage of coverage, select Deductible, Typical, Donut Hole, or Post-Donut Hole (Catastrophic).
Click the blue Set Plan link to save your settings.
The page will refresh to show you your co-pay prices at pharmacies near you, along with any discount or cash prices that may be lower than your co-pay
If you have a My Rx account, you can also edit your Medicare plan on your Settings page in the Medicare Plan section.
Once you've added your Medicare plan to GoodRx, you will see your Medicare plan name at the top of the page every time you search for a prescription. The lowest price (your co-pay, a discount, or a cash price) will be listed at each pharmacy. To see the best prices for your prescription, be sure to select your dosage and quantity using the drop down menus at the top of the page.
When pharmacies are offering prices that are lower than your Medicare co-pay, they will appear first in your results, highlighted in green. There will be instructions to the right of the price telling you what you need to do to get that price at the pharmacy: get a coupon, join a pharmacy membership club, or just pay cash (no coupon necessary).
Pharmacies where you should use your Medicare plan will appear next. They will show your co-pay as the price and have an instruction to present your insurance card.
You can change your co-pay stage, location, and plan using the blue CHANGE button next to your plan name at the top of the page. You'll want to be sure to select the stage that describes where you are currently at with your Medicare benefits, as prices vary by stage.
For most plans, there are 4 drug payment stages. Regardless of your stage, GoodRx can often help you find drugs, especially generics, for less than your Medicare price. (Note that drugs you purchase without Medicare will not count toward your deductible or getting you past the donut hole.)
You can see prices for the typical co-pay, donut hole, and post-donut hole stages on GoodRx:
Most (but not all) Medicare plans have a deductible you must reach before your benefits will kick in. You will pay more until you hit your deductible. GoodRx can often help you find drugs, especially generics, for less than your Medicare price. (Note that drugs you purchase without using Medicare will not count towards your deductible.)
This is your regular co-pay, which you'll pay until you hit the famous "donut hole."
The Donut Hole
The "donut hole," also called the "coverage gap," is a period where you are responsible for a greater share of your drug costs. In 2016, the donut hole begins at $3,310 and continues until you have spent $4,850. GoodRx can often help you find drugs, especially generics, for less than your Medicare price. Note that drugs you purchase without Medicare may not count towards closing the gap. You'll need to check with your plan to see if you can submit receipts for drugs purchased using GoodRx.
Once you've spent $4,850, you enter the "catastrophic coverage" stage, where Medicare pays most of your drug costs.
For more information on your deductible and co-pay, check with your plan. For general questions about Medicare drug coverage costs, you can find more information on Medicare.gov.
GoodRx shows you both levels of Medicare co-pay prices as well as other prices you can get when you pay cash, use a discount coupon, or use some other way besides your Medicare coverage.
When you purchase a drug with Medicare, the cost of that drug counts towards your plan's limits (described above). This can be a good thing (getting you out of the donut hole or a deductible stage more quickly), or a bad thing (putting you into the donut hole more quickly).
When you purchase a drug without using your Medicare plan, the cost of that drug will not typically count towards your limits. Some plans will allow you to submit receipts for drugs purchased without Medicare for credit towards your limits though, so check with your plan.
Ultimately, the decision whether to use your Medicare coverage is up to you. You'll want to consider the savings you would receive by not using Medicare, your expected annual drug costs, and if you will spend enough on prescriptions to enter the donut hole or post-donut hole stages. Your Medicare plan can give you more information on your total spending and help guide your decision-making.
Sadly, many drugs aren't covered by Medicare; they aren't on your plan's formulary. For most drugs, your plan will still provide a negotiated price that is better than the typical cash price, but for certain drugs you will be responsible for all of that negotiated price. In these cases GoodRx can definitely help. We'll show you the best prices when Medicare can't offer coverage.
Many Medicare drug plans place restrictions on certain medications. You can find more information on restrictions for your prescriptions by clicking on the Medicare tab to the left of the prices on any drug page.
Some drugs on Medicare have quantity restrictions, i.e. you can only buy 30 pills in a 30-day period. GoodRx will tell you those quantity limits. If you choose not to use Medicare to make your drug purchase, you will not be limited by these restrictions.
Some drugs on Medicare have prior authorization requirements—basically, your Medicare plan won't cover your prescription until it is approved. If you choose not to use Medicare to make your drug purchase, you will not be limited by these restrictions.
Many drugs on Medicare have step therapy requirements, which means your Medicare plan requires you to first try certain drugs to treat your medical condition before they will cover another drug for that condition. If you choose not to use Medicare to make your drug purchase, you will not be limited by these restrictions.
Sometimes Medicare plans will make exceptions to these restrictions; you'll want to check with your plan to be sure.
If you're having trouble paying for your Medicare prescriptions, there are resources available to help. Medicare offers Extra Help, which is a program for low-income seniors. You can learn more at the Official Website of the U.S. Social Security Administration. In addition, many non-profits and drug manufacturers offer patient assistance programs—we've described some of them here.
You can cahnge, add, or remove a plan at any time from any drug page on GoodRx.
If you already have a plan selected, look for the blue CHANGE button next to your plan name at the top of the page.
Clicking CHANGE will bring up a box to allow you to change your plan, location, or coverage state. You can also click the red REMOVE link at the bottom left of the box to remove your plan altogether.
To save your prescription and plan information for future visits, you'll need a My Rx account. You can sign up here with only an email address. If you're alerady registered, you can also make changes to your Medicare plan information from your Settings page.
If you'd like to make changes from your Settings page: Look for the Medicare Plan section near the bottom of the page. You will see your currently selected plan. Click the Change Plan button to make changes, or click the red X to remove your plan.
If you don't have a plan selected, you can click the grey Add Your Plan button to add your plan instead.
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GoodRx is not sponsored by or affiliated with any of the pharmacies identified in its price comparisons. All trademarks, brands, logos and copyright images are property of their respective owners and rights holders and are used solely to represent the products of these rights holders. This information is for informational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. GoodRx is not offering advice, recommending or endorsing any specific prescription drug, pharmacy or other information on the site. GoodRx provides no warranty for any of the pricing data or other information. Please seek medical advice before starting, changing or terminating any medical treatment.
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