Published by: Medicare Rights Center
Limits on Drug Costs
Medicare Part D plans have different coverage phases throughout the year. During these coverage phases, you pay different amounts for your drugs. In all Part D plans, you enter the catastrophic coverage phase after you reach $8,000 in out-of-pocket costs for covered drugs. This amount comprises what you pay for covered drugs and some costs that others pay.
In 2024, you have $0 cost-sharing during catastrophic coverage. This means you will not be responsible for any of the cost of your Part D-covered drugs once reaching the catastrophic coverage phase. In the past, you owed 5% of the cost of your covered drugs for the remainder of the year once in this coverage phase.
Note that beginning in 2025, your out-of-pocket drug costs will be capped at $2,000.
Extra Help
Extra Help is a federal program that helps pay for most of the out-of-pocket costs of Medicare prescription drug coverage. You are eligible for the program if your income and assets are below federally set limits. Until 2024, you would qualify for either full or partial Extra Help, depending on your income and assets.
In 2024, the Extra Help program is expanding so that all people with Medicare earning less than 150% of the federal poverty level will be eligible for full Extra Help.
The 2024 income limits have not been released yet. Until they are released, you may qualify based on your 2023 income if you also have limited assets.
The 2023 monthly income limit was $1,843 for individuals and $2,485 for couples.
To actively apply or learn more about eligibility, contact your Social Security Administration branch. Find your local branch or call the national line at 800-772-1213.
In 2024, those with full Extra Help will pay a low or no premium for their drug plan, a $0 deductible, and $4.50 copayments for generic and $11.20 copayments for brand-name drugs—those with Medicaid pay lower copays.
Drug Savings and COVID-19 Coverage
$35 Insulin
Copays for insulin for people with Medicare are limited to $35 per one month’s supply. This applies to all insulin covered by your Part D plan or under Medicare Part B.
No Cost-Sharing for Vaccines
You owe no copays or deductibles for vaccines covered by your Part D plan, including the shingles and RSV vaccines.
COVID-19 Vaccine
Original Medicare Part B covers COVID-19 vaccines and boosters, regardless of whether you have Original Medicare or a Medicare Advantage Plan. You owe no cost-sharing (deductibles, copayments, or coinsurance).
COVID-19 Testing
COVID-19 testing is covered under Medicare Part B. You pay nothing for the test if you have Original Medicare and see a participating provider or if you have a Medicare Advantage Plan and see an in-network provider.