Medicare and prescription costs — strategies that actually save money

Reviewed by the How To Help Your Elders editorial team | Updated March 2026

Switching to generic medications, applying for Medicare Extra Help, using manufacturer assistance programs, and comparing Part D plans each October can save your parent hundreds to thousands of dollars a year on prescriptions. These strategies are straightforward, and most take less than an hour to implement.

Real Savings Are Sitting on the Table

If your parent's pharmacy bill makes you both wince every time you see it, you're not alone. Prescription costs have become one of the most stressful parts of aging in America. According to KFF, the average Medicare Part D enrollee fills about 50 prescriptions per year, and out-of-pocket drug spending is a top financial concern for beneficiaries. Here's what I wish someone had told me earlier: there's real money sitting on the table if you know where to look. Not complicated pharmaceutical optimization schemes, but actual, straightforward strategies that your parent's doctor or pharmacist could explain in five minutes. The trick is knowing which questions to ask and when.

Your parent hasn't spent the last forty years thinking about generic drugs or mail-order pharmacies. Medicare is complicated enough without adding the pharmacy layer. But prescription costs are one of the few areas where you can take immediate action and see real dollar savings in weeks. Your parent doesn't need to understand all of Medicare to save money on their medications. They just need to know a few specific things, and you can help them do this.

The strategies I'm about to explain come from what pharmacy professionals, social workers, and Medicare counselors do every day for people just like your parent. Some of these savings happen automatically once you know to ask. Others require a phone call or two. All of them are within reach.

Generic Medications and Real Cost Differences

The simplest discovery about prescription costs is also the most powerful: most generic drugs work exactly as well as their brand-name equivalents and cost a fraction of the price. This isn't marketing speak. Generic medications contain the chemically identical active ingredient as the brand-name drug. The FDA requires it. Your parent isn't getting less medication; they're getting the same thing in a different package at a different price.

The cost difference is staggering. According to the FDA, generic versions typically cost 80 to 85 percent less than their brand-name counterparts. If your parent is taking a medication that costs two hundred dollars per month as a brand name, the generic version might be twenty dollars.

Here's what surprises people: sometimes doctors prescribe the brand name because insurance coverage has changed, not because the brand name is medically better. Sometimes your parent's prescriber isn't aware that a generic option has become available. Sometimes the pharmacy filled a prescription with the brand name without asking if your parent wanted the generic. None of these scenarios mean your parent should be paying more.

The strategy is simple. Before your parent leaves their doctor's office, ask the prescriber to specify generic when they write the prescription. If the prescription is already filled, call the pharmacy and ask them to fill it with the generic version instead. The medication works the same way, the side effects are the same, and the only thing that changes is the price.

When a generic first comes to market, sometimes it costs only slightly less than the brand name. As more generic manufacturers start producing the same drug, competition drives the price down further. If your parent takes a medication where the generic seems expensive, it's worth checking back in six months. The price could be significantly lower by then.

Manufacturer Assistance Programs: Free Medications You Don't Know About

Pharmaceutical companies offer assistance programs for people who can't afford their medications. These programs provide free or very low-cost medications to people who meet income requirements.

The eligibility rules are more generous than you'd expect. These programs aren't just for people without insurance. Even if your parent has Medicare, they might qualify if a specific medication is causing financial hardship. Many programs use guidelines around 150 to 200 percent of the federal poverty level.

How does your parent access these programs? The easiest way is to ask your parent's pharmacist. Pharmacists have access to databases that show which assistance programs exist for specific medications. A few minutes of the pharmacist's time can reveal whether a medication qualifies for a manufacturer program. If it does, the pharmacist can often help with the application right there at the counter.

Your parent can also call the manufacturer directly. The phone number is usually on the prescription bottle or on the manufacturer's website. Some manufacturers have simple online applications. Others want to talk to your parent directly.

These programs typically send medications by mail directly to your parent. There's no insurance company involved. No pharmacy middleman. Your parent gets the medication, and the company gets a deduction for charitable giving. The savings can be thousands of dollars per year.

The thing that prevents more people from using these programs isn't that they're hard to access. It's that people don't know they exist.

Nonprofit Programs for Disease-Specific Medications

Beyond manufacturer programs, disease-specific nonprofits also fund medications for people who can't afford them. If your parent has a chronic condition like diabetes, heart disease, or arthritis, there's likely a nonprofit organization that helps with medication costs.

Some of these nonprofits focus on a specific medication, while others help fund any treatment-related medication for their disease. Some are national, some are state-specific. The eligibility requirements vary, but most care more about whether your parent can afford the medication than about their specific income level.

Finding the right nonprofit takes a little detective work, but it's worth the time. Your parent's doctor's office might know about relevant programs. The hospital social worker almost certainly knows about nonprofits in your parent's area and for your parent's specific health conditions. Even if your parent isn't currently hospitalized, you can call the hospital and ask to speak with a social worker. This is literally their job: connecting people with resources they need.

Medicare Extra Help: The Program Most People Miss

Medicare offers a program called Extra Help (also known as the Low-Income Subsidy or LIS) that pays for Part D premiums and cost-sharing for people with lower incomes. This is a real federal program with real money behind it, yet many eligible people never apply because they've never heard of it. According to CMS, approximately 13 million Medicare beneficiaries receive Extra Help, but the Social Security Administration estimates that millions more are eligible and haven't applied.

The income limits are roughly 150 percent of the federal poverty level, which translates to about $1,600 to $1,800 per month for a single person in 2024. Asset limits are roughly $16,600 for individuals (not counting the home, car, or certain other items). These limits are generous enough that many people who think they make "too much" actually qualify.

The application process is straightforward. Your parent can apply through the Social Security Administration in person, online through the Social Security website, or by calling the number on the back of their Medicare card. The whole process takes 15 to 20 minutes.

When Extra Help is approved, Social Security communicates the subsidy amount to the Part D plan automatically. When your parent's pharmacy claim is processed, the cost-sharing amounts reflect their Extra Help status. Copays drop. The premium might disappear. The changes show up in their bills without any additional action.

One thing to know: Extra Help is retroactive three months. If your parent applies in June, it covers April, May, and June. But if they don't apply until December, they've paid the full amount for nine months. Your parent could be leaving thousands of dollars on the table just by not knowing about this program.

The Coverage Gap and Strategic Refill Timing

Medicare Part D has what's called a coverage gap (everyone calls it the donut hole). Your parent pays a certain copay for medications, then at a certain point in the year, they hit a coverage gap where they pay more. After they've spent enough, they reach catastrophic coverage and go back to lower copays.

The specific amounts change each year. As of 2025, the Inflation Reduction Act capped total out-of-pocket Part D spending at $2,000 per year, which effectively closes the donut hole for most beneficiaries. This is a significant change from previous years when patients could face thousands of dollars in the coverage gap. If your parent hasn't reviewed their Part D costs recently, they may be paying more than they need to under the new rules.

Understanding the structure matters because it affects when your parent should fill prescriptions. If your parent is approaching the out-of-pocket cap in November, it might make sense to fill several months of medication in October while costs are still accumulating toward the cap. Some pharmacies offer discount programs or bulk-buy options. If your parent buys a 90-day supply instead of a 30-day supply, the per-pill cost often drops.

Additionally, for medications where it's medically safe, some doctors agree to prescribe higher-dose pills that get split into smaller pieces, which stretches your parent's supply. This isn't appropriate for all medications, but it's worth asking about.

The Annual Review That Saves Hundreds

This might seem like administrative busywork, but it's where the biggest savings hide. The same medication your parent filled last year might have a different cost this year. Their coverage might have changed. The pharmacy they use might have different pricing for the same drugs.

Every year in October, Medicare opens the annual open enrollment period. Before December 7, your parent needs to make a decision about their plan for the next year. Most people don't think about this. They assume their plan is fine and let it renew. But even small changes in plans can mean significant savings.

Here's a concrete strategy: gather a list of your parent's current medications. Go to Medicare.gov and use the plan comparison tool. Enter each medication and see how much it would cost under different plans. You might find that a different Part D plan covers your parent's medications at a lower total cost, even if the monthly premium is slightly higher. These comparisons usually take 15 or 20 minutes and can save hundreds of dollars.

The same goes for where your parent gets their medications filled. Mail-order pharmacies often have lower costs than retail pharmacies for maintenance medications. Specialty pharmacies for expensive medications might have better pricing than a regular pharmacy. Comparing costs at a few different places might reveal that your parent could save money just by filling one or two medications somewhere different.

People who spend an hour once a year comparing plans and pharmacies often save $500 to $1,500 per year. Your parent's pharmacist can usually help with this too. Many pharmacies will run a comparison to show how their pricing compares to other local pharmacies or to mail order.

Putting This Into Practice

The strategies I've outlined are straightforward steps that your parent can take to reduce their medication costs. But knowing about them and actually using them are different things.

Start by pulling together your parent's list of current medications, including the dose and how often they take each one. This is your working document for the next few conversations.

Then call your parent's pharmacy and ask the pharmacist if any of these medications have generic versions available. If your parent is currently taking brand-name medications where generics exist, ask the pharmacist to fill the next prescription with the generic version. That conversation takes ten minutes and might save hundreds of dollars per year.

Next, go through the medication list and have your parent's doctor confirm which medications are absolutely necessary and which ones your parent takes as preventive maintenance. Ask whether any have manufacturer assistance programs or nonprofit funding. Have your parent's pharmacist help with this.

Then check your parent's current income against the Extra Help income limits. If your parent might qualify, helping them apply through Social Security takes about 20 minutes. If they're approved, the savings start the next month.

Finally, set a calendar reminder for October. Every year, spend an afternoon comparing your parent's current plan and pharmacy against alternatives. This annual check often reveals savings opportunities that didn't exist the year before because plans change and prices change.

Your parent didn't spend decades learning about pharmacy pricing and Medicare coverage. You're helping them work through something brand new. The strategies that save the most money are the simplest ones: asking for generics, checking for assistance programs, and comparing costs once a year. None of these requires a degree in healthcare finance. They just require someone to ask the right questions and listen to the answers.

Frequently Asked Questions

How much can switching to generic medications actually save?
The FDA reports that generics cost 80 to 85 percent less than brand-name drugs on average. For a medication that costs $200 per month as a brand name, the generic might cost $20 to $40. Over a year, that's $1,900 to $2,160 in savings on a single medication. If your parent takes multiple brand-name drugs with generic alternatives available, the total savings multiply.

What is Medicare Extra Help, and how do I know if my parent qualifies?
Extra Help (also called the Low-Income Subsidy) is a federal program that helps pay Part D premiums and copays. Your parent may qualify if their monthly income is roughly below $1,800 and their assets (excluding home and car) are below about $16,600. You can apply at ssa.gov, by calling Social Security at 1-800-772-1213, or at a local Social Security office.

Does the $2,000 annual cap on Part D out-of-pocket costs apply to everyone?
The $2,000 cap, established by the Inflation Reduction Act, applies to all Medicare Part D enrollees starting in 2025. This cap covers all out-of-pocket prescription costs, including deductibles, copays, and coinsurance. Once your parent reaches $2,000 in out-of-pocket spending, they pay nothing more for covered prescriptions for the rest of the year.

Can my parent use a mail-order pharmacy with Medicare Part D?
Yes. Most Part D plans offer mail-order pharmacy options, and many offer lower costs for 90-day supplies ordered by mail compared to 30-day retail fills. Your parent's plan materials or the plan's customer service line can explain how to set up mail-order prescriptions.

What if my parent's medication isn't on their Part D plan's formulary?
Your parent has several options: ask their doctor to prescribe an alternative that is on the formulary, request a formulary exception through the plan (which requires the doctor to provide medical justification), appeal if the exception is denied, or switch to a different Part D plan during annual enrollment that covers the medication.

How do I find manufacturer assistance programs for my parent's medications?
Ask your parent's pharmacist, who has access to databases of patient assistance programs. You can also search Medicare.gov's "pharmaceutical assistance program" page, visit NeedyMeds.org or RxAssist.org, or call the manufacturer directly using the phone number on the prescription bottle.