Nearly 90% of older adults take prescription medications regularly. But here’s the problem: many struggle to afford them. Between Medicare Part D premiums, deductibles, and copays, prescription costs add up fast. Some seniors skip doses or delay refills just to make their budget stretch.
You have options to reduce what you pay. Medicare Part D offers prescription drug coverage. Extra Help provides financial assistance for those who qualify. State programs and manufacturer discounts can lower costs even more. The key is knowing where to look and how to compare your choices.
This guide walks you through five practical steps to manage your prescription expenses. You’ll learn how to list your medications, understand coverage options, compare Medicare drug plans, find cost-saving programs, and get local support. By the end, you’ll know exactly how to choose a plan that covers your prescriptions while keeping your costs down.
What to know before you choose a plan
You need to understand enrollment periods before you shop for senior prescriptions coverage. The right timing can save you from penalties and gaps in coverage. Most seniors enroll during their Initial Enrollment Period (the seven months around their 65th birthday) or the Annual Enrollment Period (October 15 to December 7 each year). Missing these windows can cost you a late enrollment penalty that increases your premium permanently.
Know your enrollment windows
Your first chance to enroll starts three months before you turn 65 and extends through the month you turn 65, plus three months after. If you already have Medicare, you can switch plans during the Annual Enrollment Period. Changes take effect on January 1 of the following year. Special Enrollment Periods apply if you move, lose other coverage, or qualify for Extra Help. Mark these dates on your calendar now to avoid missing deadlines.
Most people pay a late enrollment penalty of 1% of the national base premium for each month they delay enrollment after their Initial Enrollment Period ends.
Understand what drives your costs
Three main factors determine how much you’ll pay for prescription coverage. The monthly premium is what you pay for the plan itself, typically ranging from $0 to over $100. Your annual deductible (if the plan has one) is what you pay out of pocket before coverage starts, up to $590 in 2025. Finally, copays or coinsurance apply each time you fill a prescription. These amounts vary by drug tier and plan. A generic drug might cost you $5 to $10, while a brand name could run $40 to $100 or more per month.
Check the Medicare coverage gap
Medicare Part D includes a coverage gap (sometimes called the donut hole) that affects your costs mid-year. In 2025, you enter this gap after your total drug costs reach $5,030. During the gap, you pay 25% of the cost for brand name and generic drugs. Once your out-of-pocket spending hits $8,000, catastrophic coverage kicks in and your costs drop significantly. Not all plans handle the gap the same way, so review this carefully if you take expensive medications.
Plans also use formularies, which are lists of covered drugs organized into tiers. Your medication might be on Tier 1 (lowest cost) or Tier 5 (highest cost). The tier placement directly affects what you pay at the pharmacy counter each month.
Step 1. List your prescriptions and priorities
You need a complete inventory of your medications before you compare senior prescriptions plans. Start by gathering every prescription bottle you currently take, including inhalers, creams, patches, and injections. Many people forget about medications they take only occasionally, like antibiotics or pain relievers, but these count too. Write down the exact drug name (both brand and generic), dosage, and how often you take it. This list becomes your comparison tool when you evaluate different plans.
Document your current medications
Create a spreadsheet or simple table with the following information for each prescription. You need the drug name (generic and brand if applicable), strength (like 10mg or 500mg), quantity (such as 30 tablets), and frequency (how many times per month you refill). Add the pharmacy name where you currently fill each prescription. Include your prescribing doctor’s contact information in case plans need verification. This documentation saves you time when you call insurance companies or use online comparison tools.
MEDICATION INVENTORY TEMPLATE
Drug Name (Generic/Brand): _______________
Strength/Dosage: _______________
Quantity per Fill: _______________
Refills per Year: _______________
Current Monthly Cost: $_______________
Prescribing Doctor: _______________
Pharmacy: _______________
Medical Condition Treated: _______________
Rank your medication priorities
Not all prescriptions carry the same weight in your decision. Identify which medications you absolutely must have covered by the plan. These typically include drugs for chronic conditions like diabetes, heart disease, or high blood pressure. Mark these as "critical" on your list. Next, separate medications you take regularly but could potentially substitute with generics or alternatives. Finally, list any prescriptions you use occasionally or seasonally, like allergy medications or antibiotics.
Plans that cover your most expensive or critical medications save you the most money, even if their monthly premium costs slightly more.
Consider which pharmacies you prefer to use. Some plans restrict coverage to specific pharmacy networks. If you rely on mail order delivery for convenience or use a local independent pharmacy like Value Drugstore, you need a plan that supports those options. Factor in any mobility limitations or transportation challenges that affect where you can pick up medications.
Step 2. Understand your coverage options
You have several ways to get prescription drug coverage through Medicare. The right choice depends on your current Medicare enrollment, budget, and healthcare needs. Most seniors choose between standalone Medicare Part D plans or Medicare Advantage plans that include drug coverage (MA-PD). Additionally, financial assistance programs like Extra Help can reduce your costs regardless of which coverage type you select. Understanding these options now prevents confusion when you’re ready to enroll.
Medicare Part D standalone plans
Standalone Part D plans work alongside your Original Medicare (Parts A and B). You keep your current doctors and Medicare coverage, then add a separate prescription drug plan from a private insurance company. These plans cover most generic and brand name drugs at participating pharmacies. You pay a monthly premium directly to the insurance company, typically between $0 and $100+ depending on the plan’s coverage level and your location.
Choose a standalone Part D plan if you want to keep Original Medicare and prefer the flexibility to see any doctor who accepts Medicare. These plans let you add a separate Medicare Supplement (Medigap) policy if you want help covering deductibles and copays. Standalone plans also work well if you already have prescription coverage through a former employer or union and want backup coverage.
Medicare Advantage with drug coverage
Medicare Advantage plans (Part C) bundle hospital, medical, and prescription coverage into one combined plan. Most Medicare Advantage plans include drug coverage automatically, though you should verify this before enrolling. These plans often add extra benefits like dental, vision, and hearing coverage that Original Medicare doesn’t provide. You pay the plan’s monthly premium (sometimes $0) plus your Part B premium.
The trade-off involves network restrictions. Medicare Advantage plans require you to use specific doctors, hospitals, and pharmacies in the plan’s network (except in emergencies). Your prescription costs and coverage depend entirely on the plan’s formulary and pharmacy network. If your preferred pharmacy or medications aren’t covered, you’ll face higher costs or need to switch providers.
You cannot have both a standalone Part D plan and a Medicare Advantage plan at the same time. Enrolling in one automatically cancels the other.
Extra Help and financial assistance programs
Extra Help (also called the Low-Income Subsidy) reduces prescription costs for seniors who meet income and asset requirements. If you qualify, you’ll pay no more than $4.50 for generic drugs and $11.20 for brand name drugs in 2025, with no deductible or coverage gap. Your monthly premium drops to $0 or a very low amount. Income limits for 2025 are $23,895 for individuals or $32,235 for couples, with asset limits of $17,220 (individual) or $34,360 (couple).
Apply for Extra Help through the Social Security Administration online, by phone at 1-800-772-1213, or at your local Social Security office. You’ll need documentation of your income, assets, and living expenses. Many people qualify automatically if they receive Medicaid, Supplemental Security Income (SSI), or state pharmaceutical assistance. State programs and drug manufacturer assistance can provide additional help beyond Extra Help, especially for expensive medications.
EXTRA HELP QUICK ELIGIBILITY CHECK
Income (2025):
□ Single: Under $23,895/year
□ Married: Under $32,235/year
Assets (excluding home/car):
□ Single: Under $17,220
□ Married: Under $34,360
Automatic Qualification:
□ Already receive Medicaid
□ Already receive SSI
□ State pays your Medicare premiums
Application: ssa.gov or call 1-800-772-1213
State Pharmaceutical Assistance Programs (SPAPs) operate in many states and offer help based on different eligibility rules than federal programs. Contact your State Health Insurance Assistance Program (SHIP) to learn about local assistance options for senior prescriptions that might work alongside your Medicare coverage.
Step 3. Compare Medicare drug plans
You need to compare plans side by side to find the best coverage for your senior prescriptions. The comparison process takes about 30 to 45 minutes when you have your medication list ready. Start by visiting the official Medicare Plan Finder at Medicare.gov, which shows all available plans in your area with accurate, up-to-date pricing and coverage information. Private insurance websites often display incomplete data or steer you toward specific plans, so stick with the official Medicare tool for your initial research.
Use the Medicare Plan Finder tool
Navigate to Medicare.gov/plan-compare to access the Plan Finder tool. You’ll answer questions about your current Medicare coverage, zip code, and whether you qualify for Extra Help. The tool asks if you want to include your doctors and pharmacies in the search, which helps narrow results to plans that work with your preferred providers. Enter each medication from your list, including the exact dosage and quantity you take monthly. The system automatically calculates your estimated annual costs for each available plan based on your specific prescriptions.
The Plan Finder displays results ranked by total estimated annual cost, not just monthly premium. A plan with a $0 premium might cost you $3,000 per year in copays, while a $40 premium plan could total only $1,200 annually. Review at least three to five plans that rank lowest for your total costs. Print or save the comparison chart that shows how much you’ll pay for each prescription under different plans.
Check each plan’s formulary coverage
Every plan maintains a formulary that lists which drugs it covers and at what tier. You need to verify that all your medications appear on the formulary before you enroll. Click on each plan’s formulary link in the Plan Finder results. Search for your medications by generic name first, since plans typically list drugs this way. Note which tier the plan assigns to each medication (Tier 1 through Tier 5).
Plans can require prior authorization or step therapy for certain drugs, especially expensive brand names. Prior authorization means your doctor must prove medical necessity before the plan approves coverage. Step therapy requires you to try a cheaper alternative first before the plan covers your preferred medication. These restrictions appear in the formulary details next to each drug. If you see "PA" (prior authorization), "ST" (step therapy), or "QL" (quantity limits) next to your medications, factor in the extra time and effort required to get your prescriptions filled.
Plans can change their formularies mid-year for certain drugs, but they must notify you at least 60 days before removing a medication you currently take.
Calculate your total annual costs
Add up all costs you’ll pay over 12 months to get the real price of each plan. Start with the monthly premium multiplied by 12. Add the annual deductible if the plan charges one (up to $590 in 2025). Then calculate your estimated copays by multiplying each drug’s copay by the number of fills per year. Include the coverage gap costs if your total drug expenses will exceed $5,030.
ANNUAL COST CALCULATOR
Monthly Premium × 12 = $______
Annual Deductible = $______
Prescription Copays (all drugs, all fills) = $______
Coverage Gap Costs (if applicable) = $______
TOTAL ANNUAL COST = $______
Example:
Monthly Premium × 12 = $468 ($39/month)
Annual Deductible = $250
Prescription Copays = $840 (7 drugs × $10 copay × 12 fills)
Coverage Gap Costs = $0 (under threshold)
TOTAL ANNUAL COST = $1,558
Compare these totals across your top three to five plans. The plan with the lowest total wins, even if its monthly premium looks higher at first glance. Factor in potential changes too. If your doctor might prescribe new medications next year or increase dosages, choose a plan with better formulary coverage for similar drug classes.
Review pharmacy networks and restrictions
Plans restrict which pharmacies you can use to get the lowest copays. Check whether your preferred pharmacy participates in each plan’s network as a standard or preferred pharmacy. Preferred pharmacies offer lower copays than standard network pharmacies. The Plan Finder shows which pharmacies work with each plan, including national chains, independent pharmacies, and mail order services.
Mail order typically provides 90-day supplies at lower costs than 30-day retail fills. Calculate whether mail order saves you money by comparing the 90-day copay to three separate 30-day retail copays. Some plans require mail order for maintenance medications after your first few fills. Verify that any specialty pharmacies your doctors use for injectable or high-cost drugs participate in the plan’s network, since these medications often require specific pharmacy handling.
Step 4. Lower your prescription costs
You can reduce what you pay for senior prescriptions through several proven strategies that work alongside your Medicare coverage. Most people overpay simply because they don’t ask about available discounts or explore cost-saving alternatives. These tactics take minimal effort but can save you hundreds or thousands of dollars annually. Apply these methods immediately to lower your prescription expenses starting with your next pharmacy visit.
Ask about generic alternatives
Generic drugs contain the same active ingredients as brand name medications and work just as effectively, but cost 80% to 85% less on average. Your doctor might prescribe a brand name out of habit without realizing a generic version exists or that you’re paying high copays. Call your doctor’s office and ask them to review your medication list specifically for generic substitutions. Most doctors willingly switch prescriptions when you explain the cost difference impacts your ability to take medications as prescribed.
Pharmacists can also suggest generic alternatives if your prescription allows substitution. When you pick up a new prescription, ask "Is there a generic version of this medication?" or "What’s the price difference between the brand and generic?" Some insurance plans require you to try generics before approving brand name coverage through step therapy. Getting ahead of this requirement saves you time and frustration at the pharmacy counter.
Use prescription discount programs and manufacturer coupons
Prescription discount cards and manufacturer savings programs can lower your costs when Medicare coverage falls short. Programs like GoodRx, SingleCare, and RxSaver offer free discount cards that work at most pharmacies, sometimes reducing prices below your Medicare copays for specific drugs. Compare the discount card price against your plan’s copay before filling each prescription. You cannot use discount cards and Medicare coverage together for the same prescription, so choose whichever costs less.
Drug manufacturers offer patient assistance programs and copay cards that reduce or eliminate costs for expensive brand name medications. Visit the manufacturer’s website for each of your brand name drugs and search for "patient assistance" or "savings program." Many programs provide medications free or at steep discounts if you meet income requirements. Apply directly through the manufacturer or ask your doctor’s office to help with the paperwork.
Manufacturer copay assistance programs can reduce brand name drug costs to $0 to $25 per month, even for medications that normally cost hundreds of dollars.
DISCOUNT PROGRAM CHECKLIST
Before filling your prescription:
□ Ask pharmacist for generic version and price
□ Check discount card price (GoodRx, SingleCare, RxSaver)
□ Compare discount price vs. Medicare copay
□ Visit drug manufacturer website for savings programs
□ Ask about manufacturer copay cards at pharmacy
□ Use whichever option costs you less
Example savings:
Brand name with Medicare: $87 copay
Same drug with discount card: $42
Same drug with manufacturer coupon: $15
YOUR CHOICE: Use manufacturer coupon
Request 90-day supplies through mail order
Switching from 30-day retail fills to 90-day mail order cuts your prescription costs significantly. Most Medicare Part D plans charge lower copays for 90-day supplies, typically 2 to 2.5 times the 30-day copay instead of 3 times. You pay for two months and get the third month at a reduced rate or free. This approach also reduces trips to the pharmacy and ensures you don’t run out of medications between refills.
Contact your plan’s mail order pharmacy or ask your doctor to send prescriptions directly to the mail service. Plan ahead since mail order takes 7 to 10 days for initial orders. Keep a small supply of each medication on hand when you transition to mail order so you don’t experience gaps in coverage. Not all medications qualify for mail order (particularly refrigerated or controlled substances), but most maintenance drugs for chronic conditions work perfectly with this delivery method.
Split higher-dose tablets when appropriate
Pill splitting lets you get two doses for the price of one if your medication comes in scored tablets designed for splitting. Ask your doctor to prescribe double your current dose, then split each tablet in half. A 20mg tablet costs nearly the same as a 10mg tablet, so you effectively cut your medication cost in half. Your pharmacist can verify whether your specific medication is safe to split and recommend an inexpensive pill splitter tool (under $10).
This strategy works best for medications you take long-term at stable doses. Never split extended-release, enteric-coated, or capsule medications, as this destroys their time-release properties and can cause dangerous side effects. Confirm with both your doctor and pharmacist before splitting any medication to ensure you don’t compromise effectiveness or safety.
Step 5. Get local help with senior prescriptions
You don’t have to navigate prescription coverage alone. Free local resources provide personalized guidance tailored to your specific situation. These programs employ trained counselors who understand Medicare rules and can help you make informed decisions about senior prescriptions. Many people discover savings opportunities they never knew existed simply by talking with a local expert who reviews their unique circumstances.
Connect with your State Health Insurance Assistance Program (SHIP)
SHIP offers free, unbiased counseling about Medicare prescription drug plans through volunteers and staff in every state. These counselors don’t sell insurance, so they provide objective advice focused solely on your needs. Call 1-800-MEDICARE (1-800-633-4227) to get your local SHIP contact information, or search online for "SHIP" plus your state name. Schedule an appointment to bring your medication list and current plan details for a complete review.
SHIP counselors help you compare plans during enrollment periods, understand your coverage, file appeals when plans deny medications, and identify financial assistance programs. They walk through the Medicare Plan Finder with you and explain exactly what each option means for your budget. Most SHIP offices operate at senior centers, libraries, or Area Agencies on Aging, making them easily accessible without traveling far from home.
SHIP counselors saved Medicare beneficiaries an average of $8,700 per person in 2024 by helping them find better prescription drug coverage and financial assistance programs.
Visit your local independent pharmacy for personalized guidance
Independent pharmacies like Value Drugstore provide individualized attention that large chains often can’t match. Your pharmacist knows your medication history and can suggest cost-saving strategies specific to your prescriptions. Stop by or call to discuss which Medicare plans work best with their pharmacy, ask about generic alternatives, and learn about manufacturer discount programs they can help you access.
Local pharmacists often identify potential drug interactions, recommend therapeutic substitutions that cost less, and coordinate with your doctors to adjust prescriptions for better affordability. They can also help you apply for patient assistance programs and explain how to use discount cards effectively.
Use community resources and senior centers
Community centers and local senior organizations host free Medicare education workshops during enrollment periods. These sessions cover prescription drug plans, financial assistance, and strategies to reduce costs. Contact your local Area Agency on Aging to find workshops near you. Many organizations also offer one-on-one counseling appointments with trained volunteers who help you complete applications for Extra Help and other programs.
Next steps for your prescriptions
You now have a clear roadmap to manage your senior prescriptions affordably. Start by updating your medication inventory today, then mark the next enrollment period on your calendar (October 15 to December 7 for Annual Enrollment). Compare at least three plans using the Medicare Plan Finder tool, focusing on total annual costs rather than just monthly premiums. Don’t forget to check whether your current medications appear on each plan’s formulary and verify that your preferred pharmacy participates in the network.
Take action on the cost-saving strategies immediately. Call your doctor about generic alternatives, research manufacturer assistance programs for expensive medications, and consider switching to 90-day mail order supplies for your maintenance drugs. Schedule a free consultation with your SHIP counselor or local pharmacist to review your specific situation and catch opportunities you might have missed.
Looking for a pharmacy that provides personalized guidance on prescription coverage? Learn how Value Drugstore combines affordability with individualized care to help you navigate Medicare plans and reduce your medication costs. Our pharmacists take time to understand your unique needs and work directly with your insurance to maximize your benefits.
