03/05/2026
Medicare Copay Extra Help!
Ok, so, first of the year saw many people getting hit with some larger copays than expected. Sure, deductibles reset and if you’ve been on Medicare for a while, you know it tends to be more expensive in the beginning of the year than at the end. But this year feels a bit worse than normal. Good news is that the maximum out of pocket is still set fairly low ($2,100, which is a lot, but better than some years in the past), but getting to that point can still be painful for many people.
This is a good time to review if you qualify for Extra Help for Medicare prescription drug costs. This is a program that has income restrictions, but it would help bring your copays down significantly if you haven’t been on it before. Criteria include an income limit and a resource (stocks, retirement, savings, etc - NOT Home, car, burial expenses, furniture, one car). Income limit is $23,940 for an individual or $32,460 for a couple. Resource limits are $18,090 for an individual or $36,100 for a couple. These limits do change yearly. We’ve included the link to the application - definitely has been a big help for people in the past. If you qualify for it, you may as well use it. I hate seeing people skipping their life saving medications because they have to choose between groceries/rent or medication.
Also, for those that have copays on Medicare, consider a M3P/MPPP plan. No, not MP3 - those are sound files. Not sure why they went with that name, but here we are. Medicare Prescription Payment Plans are offered by all Medicare plans. Think of it as a legal charge account with Medicare, if I’m understanding it correctly. There is no fee for enrolling in a M3P. You have $0 copays due at the pharmacy register. A bill will come from Medicare monthly for your share of the copays. So you will still pay for the medication, just might have a little more time to do it. The customer service number on the back of your drug coverage card should be able to help you sign up. From what I’ve heard, it’s very easy to signup and the MPPP coverage takes place within hours.
If you have any questions on any of the above, feel free to reach out to me at the pharmacy or DM via Facebook.
- Dr. Shawn
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