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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 Prolia
It's not always clear when side effects from Prolia will start because everyone is different. Some people might feel mild pain in their back, arms, legs, muscles, or joints. Others might have more severe pain that can happen days or even months after the injection. There's also a rare risk of thigh bone fractures. This can feel like a dull ache in your hip, thigh, or groin lasting weeks or months. If you notice any new or unusual hip, thigh, or groin pain, call your care team to check it out. Also talk to your care team if you have other side effects that won't go away or bothers you a lot.
You'll get Prolia as an injection under the skin once every 6 months. A trained healthcare professional will help inject it usually at their clinic or office. It's injected into your upper arm, upper thigh, or stomach. Check with your prescriber about your options on how to get your Prolia injection.
No, Prolia isn't a bisphosphonate. It's a different type of medication called a monoclonal antibody. Both types can help treat osteoporosis, but they work in different ways. Bisphosphonates like alendronate (Fosamax) are usually the first choice. But your prescriber might choose Prolia instead if you have side effects you can't tolerate from bisphosphonates. Ask your prescriber which type of osteoporosis medication is right for you.
Based on current research, Prolia isn't known to cause cancer. Some people with cancer might need to take this medication. This includes women taking certain medications for breast cancer who are at high risk of fractures. It also includes men taking certain medications for prostate cancer with a high risk of breaking a bone. Prolia can help make their bones stronger and prevent fractures. Talk to your prescriber if you have other questions about this.
There are rare reports of people who had hair loss after starting Prolia. It's not clear whether this hair loss was caused by Prolia. More research is needed to explore about hair loss and this medication. If you notice any concerning hair loss while taking Prolia, let your care team know. They can help you figure out what's causing it.
You can keep taking Prolia as long as it helps your bones and doesn't cause serious side effects. You only need one Prolia injection every 6 months. It keeps working over time to make your bones stronger and lower your chance of fractures. Before deciding to stop Prolia, talk to your prescriber. They can help come up with a plan to keep your risk of fracture low. Ask your prescriber how long you should take Prolia.
Prolia and and Xgeva are both medications with the same active ingredient: denosumab. They're both injections given under the skin. But they can't be used in place of one another. This is because the medications treat different conditions and have different dosing. Prolia helps treat osteoporosis in certain people who are at high risk of fracture. It's given once every 6 months. But Xgeva is used to help with bone or calcium issues related to certain cancers, like multiple myeloma. It's given once a month at a higher dose than Prolia. You shouldn't take Prolia and Xgeva at the same time because it can raise your risk of side effects. Ask your prescriber if you have more questions about differences between these medications.
Prolia and Evenity (romosozumab) are both injections under the skin for osteoporosis. But they have some differences. Both can help postmenopausal women who have a high risk of fractures. But Prolia can also be used for men with osteoporosis, osteoporosis caused by steroid use, and people taking certain cancer medications. In addition, Prolia is given once every 6 months for as long as needed. Evenity is given once a month but only for up to 1 year. Evenity also has a rare risk of heart problems, so it might not be right for people with heart issues. Ask your prescriber to compare and see which is best for you.
