Your Situation
Help With Prescription Drug Costs
Drug costs are one of the biggest financial concerns for people on Medicare. Several programs can reduce what you pay — some dramatically. Here's what's available and how to access it.
Extra Help (Low Income Subsidy)
Extra Help is a federal program that can reduce or eliminate your Part D premiums, deductibles, and copays. For many people who qualify, drug costs drop to just a few dollars per prescription.
Who qualifies
- • Income generally at or below ~150% of the Federal Poverty Level
- • Asset limits apply (excluding your home, car, and personal belongings)
- • Both income and assets are counted — thresholds adjust each year
What it covers
- • Reduced or $0 Part D premium
- • Reduced or $0 annual deductible
- • Copays as low as a few dollars per prescription
- • No coverage gap — continuous reduced cost all year
Apply through Social Security: ssa.gov or call 1-800-772-1213. You can also apply at your local Social Security office or through Wisconsin's Aging and Disability Resource Center (ADRC).
Wisconsin SeniorCare
Wisconsin-Only Program
SeniorCare is a Wisconsin state drug assistance program specifically for residents age 65 and older. It's separate from Medicare Part D and can be a better fit for some people — especially those with moderate incomes who take a small number of medications.
- • Eligibility: Wisconsin resident, age 65+, not on Medicaid. No income cap; your income sets your yearly deductible.
- • Annual enrollment fee: $30
- • Drug cost: $5 per generic and $15 per brand-name prescription
- • Coverage: A broad list of prescription drugs; check that yours are covered before enrolling
SeniorCare can coordinate with Medicare Part D for some enrollees. It may serve as your primary drug coverage in place of Part D if it better meets your needs.
Apply for SeniorCare at dhs.wisconsin.gov → | More about Wisconsin's unique Medicare programs →
The Part D Out-of-Pocket Cap
Beginning in 2025, there is a hard cap on what you pay out of pocket for covered Part D drugs each year. In 2026, that cap is $2,100, and it rises to $2,400 in 2027. Once you reach it, your copays for covered drugs drop to $0 for the rest of the year.
This is a significant protection for people on high-cost specialty medications. If your drugs are expensive, you won't face unlimited out-of-pocket exposure — your costs stop at the yearly Part D cap.
Is Your Plan Covering Your Drugs Efficiently?
Even if you don't qualify for Extra Help or SeniorCare, you may be paying more than you need to by being on the wrong plan. Drug costs differ widely between Part D plans — the same medication can be on a different tier (and cost much more) depending on which plan you have.
Annual Enrollment Period (Oct 15 – Dec 7): You can switch Part D plans each year. If your drugs are expensive under your current plan, compare alternatives during AEP for coverage starting Jan 1.
Check your plan's formulary: Each plan publishes a list of covered drugs and their tier (which determines your copay). Your pharmacist or plan's member portal can tell you your tier for each drug.
Consider Medicare Advantage (MAPD): If you're on Original Medicare + Part D, some MAPD plans in Wisconsin may offer better drug coverage for your specific medications. Comparing both paths is worth the time.
Spreading Costs With the Medicare Prescription Payment Plan (M3P)
If you take expensive medications and tend to hit high drug costs early in the year, the Medicare Prescription Payment Plan (M3P) can help smooth out your cash flow — even if it doesn't reduce your total spending.
How it works
- • Instead of paying large out-of-pocket amounts at the pharmacy, your costs are spread across equal monthly payments through the end of the year
- • Available starting in 2025 through any Part D or MAPD plan
- • You opt in through your plan — it's voluntary
What it doesn't do
- • It does not reduce your total drug costs — it only changes when you pay
- • Best suited for people who hit high drug costs in the first few months of the year and need to manage cash flow
- • If you enroll late in the year, there's less benefit since remaining months are fewer
Contact your plan to opt in — you can typically enroll at any time during the plan year.
Buying Drugs Directly at Cost
For some drugs, bypassing insurance entirely and paying the manufacturer's cost price can be significantly cheaper than your plan's copay. Cost Plus Drugs (costplusdrugs.com) is a transparent-pricing pharmacy that sells hundreds of generic and some brand-name drugs at cost plus a small fixed markup.
How the pricing works: Cost Plus Drugs charges the manufacturer's cost plus 15% markup plus a $5 pharmacy fee per prescription. Many common generics cost just a few dollars — sometimes less than your insurance copay.
Important Medicare caveat: Amounts you pay at Cost Plus Drugs do not count toward your Part D deductible or out-of-pocket cap. If reaching the yearly out-of-pocket cap matters to you (because your other drugs are expensive), using insurance may still be better even if the Cost Plus price seems lower.
Best use case: A drug you take regularly that isn't well covered by your plan, isn't on formulary, or has a very high tier copay — and that you don't need to count toward your OOP cap. Worth checking the price before filling any new prescription.
Part D – Drug Coverage
How Part D works, tiers, and penalties →
Why WI Is Different
SeniorCare and Wisconsin's unique programs →
Still have questions? Talk with Marit.
Licensed Wisconsin agent in downtown Appleton. No cost to talk, no pressure to enroll.
Or send us a message →