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Need help with prescription drug costs? Prescription Advantage may be your answer!

By now, some of you may have reached or are getting close to the gap or “doughnut hole” with your Medicare Prescription Drug Plan (Part D). In 2022, you fall into the Medicare Part D gap when the negotiated retail cost of your medications reaches $4,430. Once in the gap, you are now responsible for 25 percent of the negotiated retail cost for brand-name medications, and 25 percent for generics. Prescription Advantage, which is a state-run program, can assist you in this gap and/or put a cap on your out-of-pocket cost for medications.

Do you need to change your prescription plan?  Being a member of Prescription Advantage allows you to change your prescription plan one time outside of Open Enrollment.

Don’t have a prescription plan and need one? Being a member of Prescription Advantage would allow you to enroll in a plan without having to wait for Open Enrollment.

Eligibility is based on income only, and there is no asset limit.

If you are a Massachusetts resident and eligible for Medicare, the income limits are:

  • Age 65 or over — $67,950 or less for a single person, or $91,550 or less for a married couple.
  • Under age 65 and disabled — $25,549 or less for a single person, or $34,423 or less for a married couple.

There is no charge for joining Prescription Advantage if you have an annual income at or less than $40,770 for a single person or $54,930 for a married couple. However, there is a $200 per person annual enrollment fee for those with higher incomes.

You may also join if you are 65 years or older and not eligible for Medicare.  If you are not eligible for Medicare, Prescription Advantage will be your primary prescription drug plan, and there is no income limit.

Medicare also has a program, called “Extra Help,” which can assist with the cost of your Medicare Part D plan’s premium, deductible and copays. Please call the Senior Center to make an appointment with a SHINE counselor for more information on these programs or assistance with any Medicare issue. Trained SHINE volunteers offer free, confidential counseling on all aspects of Medicare and related health insurance programs.

Helpful websites and telephone numbers

  • Social Security: ssa.gov, 800-772-1213