Help Paying for Your Prescriptions: A Complete Guide to Part D Assistance Programs (2025)

Medicare Part D helps cover prescription drug costs, but even with the new $2,000 out-of-pocket cap in 2025, medications can still be expensive. The good news is that multiple programs—federal and state—can lower your costs dramatically. Most people who qualify don't even know these programs exist.

This guide breaks down every major assistance option available in 2025 so you can get the financial help you deserve.

Federal Program: Extra Help (Low-Income Subsidy)

What Is Extra Help?

Extra Help—officially the Low-Income Subsidy (LIS)—helps people with limited income pay for:

• Part D monthly premiums
• Deductibles
• Prescription drug costs

The Social Security Administration estimates the program is worth about $6,200 per year for the average enrollee.

Who Qualifies for Extra Help in 2025?

Income Limits (2025):

• Individual: Up to $2,332/month (~$27,984/year)
• Couple: Up to $3,152/month (~$37,824/year)

Resource Limits (2025):

• Individual: Up to $17,820
• Couple: Up to $35,940
• Plus: $1,500 per person burial allowance

Assets that count: Savings, checking, stocks, bonds, mutual funds, IRAs, 401(k)s, real estate (other than your home)

Assets that do NOT count: Your home, your car, personal belongings, life insurance, burial funds

What Extra Help Covers in 2025

This is where the big change happens. In prior years, Extra Help required very small copays (e.g., ~$4.90/$12.15 in 2024). But starting in 2025:

This is one of the best financial help programs available to Medicare beneficiaries.

Who Gets Extra Help Automatically?

You don't need to apply if you have:

• Full Medicaid
• SSI (Supplemental Security Income)
• A Medicare Savings Program (QMB, SLMB, or QI)

Medicare will automatically enroll you.

How to Apply for Extra Help

Apply any time using one of these methods:

• Online: SSA.gov/medicare/prescriptionhelp
• Phone: 1-800-772-1213
• In Person: At your local Social Security office
• By Mail: Form SSA-1020

There is no fee to apply.

LINET (Limited Income Newly Eligible Transition Program)

LINET gives temporary Part D coverage to people who qualify for Extra Help but are not yet enrolled in a Part D plan.

• Covers you for up to two months
• May provide retroactive coverage
• Hotline: 1-800-783-1307

New York State Program: EPIC

EPIC is not a Part D plan—it works alongside your Part D plan to reduce your costs.

Who Qualifies?

• Age 65+
• New York State resident
• Enrolled in (or eligible for) Medicare Part D
• Not receiving full Medicaid benefits

Income Limits (2025):

• Single: Up to $75,000
• Married couple: Up to $100,000

There is NO asset limit.

What EPIC Covers

EPIC helps with:

• Part D monthly premiums (up to the NY benchmark: $72.34 in 2025)
• Deductibles
• Copays after your plan pays
• Some medications that Part D may not cover

If you also have Extra Help, New York will apply BOTH subsidy amounts—potentially covering up to $144.68/month of your Part D premium.

EPIC Has Two Plans

1. Fee Plan - For incomes up to $23,000 (single) or $29,000 (married):

• You pay low EPIC copays: $3–$20
• No EPIC deductible
• EPIC pays your Part D premium up to the benchmark

2. Deductible Plan - For incomes $23,001–$75,000 (single) or $29,001–$100,000 (married):

• You first meet an EPIC deductible ($530–$3,215)
• The deductible is reduced by the annual cost of a benchmark Part D premium (~$868 in 2025)
• Afterward, EPIC copays apply: $3–$20

How to Apply (NY Residents)

• Online: health.ny.gov/health_care/epic
• Phone: 1-800-332-3742
• Mail: EPIC, PO Box 15018, Albany, NY 12212-5018

No documents are required; EPIC verifies everything automatically.

New Jersey Programs: PAAD & Senior Gold

New Jersey provides two powerful drug cost assistance programs.

PAAD (Pharmaceutical Assistance to the Aged & Disabled)

Who Qualifies for PAAD?

• Age 65+ or age 18–64 receiving SSD benefits
• New Jersey resident
• Enrolled in Medicare Part D
• Not receiving full Medicaid benefits

Income Limits (2025):

• Individual: Less than $53,238
• Couple: Less than $60,424

No asset test.

What PAAD Covers:

• Your Part D premium (up to the benchmark)
• You pay $5 for generics and $7 for brand-name drugs
• PAAD covers the rest

Example: Your prescription cost after Part D = $100. PAAD pays $93. You pay $7 (brand) or $5 (generic).

Senior Gold

For people who don't qualify for PAAD but still need help.

Income Limits (2025):

• Individual: $53,238–$75,000
• Couple: $60,424–$100,000

What Senior Gold Covers: You pay $15 copay, then 50% of the remaining cost.

Example: Drug cost after Part D = $100. You pay $15 + 50% of $85 = $57.50

Annual Out-of-Pocket Cap: $2,000 for individuals, $3,000 for couples. After hitting the cap, you pay $15 per prescription for the rest of the year.

How to Apply (NJ Residents)

• Online: state.nj.us/humanservices/doas/paad
• Phone: 1-800-792-8820
• Mail: PAAD/Senior Gold, PO Box 716, Trenton, NJ 08625-0716

Other State Programs

Many states have programs similar to EPIC and PAAD. Examples include:

• Pennsylvania: PACE and PACENET
• Connecticut: ConnPACE
• Delaware: DPAP
• Maine: Drugs for the Elderly

Contact your state's Department of Aging or search online for "[Your State] + prescription drug assistance" to find local options.

Manufacturer Assistance Programs

Many drug manufacturers offer their own patient assistance programs (PAPs). These programs may provide medications at little or no cost if you meet income requirements.

Resources to find PAPs:

• Medicare.gov: Search for pharmaceutical assistance programs
• NeedyMeds.org: Database of PAPs and other assistance
• RxAssist.org: Comprehensive database of patient assistance

Your Next Steps

1. Check if you qualify for Extra Help at SSA.gov
2. If you're in NY or NJ, apply for EPIC/PAAD
3. Review your Part D plan's formulary for your medications
4. Ask your doctor about generic alternatives
5. Check manufacturer programs for expensive medications

Need Help Navigating These Programs?

These programs can save you thousands of dollars each year, but the applications and rules can be confusing. At SageAlly, we help seniors and families:

• Determine which programs you qualify for
• Complete applications correctly
• Appeal denials
• Coordinate multiple programs for maximum savings

Disclaimer: This information is for educational purposes only. Program rules and income limits change annually—verify current information with official sources.