Coverage for Prescription Drugs
Individuals who have Medicare Part A and/or Part B may enroll in a Part D plan.
- Medicare Part D plans are offered by private insurance companies and must be approved by Medicare.
- Plans vary in premium and coverage (covered drugs, co-payments and deductibles, preferred pharmacies and mail order options).
- Not enrolling in a Medicare Part D plan, when you are eligible, may result in a late enrollment penalty.
- You do not need to enroll in a Part D plan if you have “creditable” drug coverage through an employer policy, VA benefits or TriCare for Life.
You should evaluate your Medicare Part D plan every year between October 15 and December 7. Most people find they can save money if they switch to a different plans. Your new plan will begin January 1 of the next year.
How to Select a Medicare Prescription Drug Plan
Contact SHIP at 301-255-4250 for help in evaluating your options. Submit your request for a free Medicare Part D Plan comparison using our secure online request form on our Forms & Resources page. We will evaluate your options and send you lowest cost Medicare prescription drug plan options to consider.
For a guide to how to enter your drugs and shop for a Medicare Part D Plan, use Medicare’s Plan Finder tool to evaluate the best policy on your own. Watch Medicare’s step-by-step video about How to use Medicare Plan Finder.
Ways to Save Money with Your Part D Prescription Drug Plan
Currently there are two Programs available to reduce your Part D prescription drug costs. These are the Low Income Subsidy (LIS) and Maryland’s Senior Prescription Drug Assistance Program (SPDAP). Each is detailed below.
ELIGIBILITY STANDARDS for Extra Help and SPDAP in 2021
| Monthly Income* | Annual Income | Assets** | ||
| Extra Help/LIS
|
Single | $1,630 | $19,560 | $14,790 |
| Couple | $2,198 | $26,376 | $29,520 | |
| SPDAP
Senior Prescription Drug Assistance Program |
Single | $3,220 | $38,640 | No Asset Limit |
| Couple | $4,355 | $52,260 | No Asset Limit |
Help Paying for Prescription Drug Costs
Extra Help (or Low Income Subsidy)
The Federal Government’s Extra Help program is administered by Social Security. If you qualify, you get help paying for your Medicare Part D plan’s monthly premium, deductible, and for some of the costs of your prescriptions. You also have the option to change your Rx Part D plan every month.
To be eligible for Extra Help, income should be at or below $19,560 for an individual or $26,376 for a couple. Income can be higher if you are working and a portion of your income is from earned wages.
There is also an asset test of $14,790 or less for a single person and $29,520 or less for a couple. Assets include savings, stocks, bonds, IRAs but not your home or car.
How to Apply for Extra Help
Extra Help applications can be completed online at the Extra Help Application page or are available by mail from the SHIP office at 301-255-4250. You can also apply directly through Social Security Office at 1-800-772-1213.
Maryland Senior Prescription Drug Assistance Program (SPDAP)
The State of Maryland program that provides eligible Medicare beneficiaries with help paying their premiums and/or cost sharing for Medicare Part D prescription drug Plans. If you are eligible for SPDAP, you may have one more time during the year to change your Medicare Part D Drug Plan.
You may be eligible if your income is at or below $38,640 ($3,220 monthly) for a single person or $52,260 ($4,355 monthly) for a couple — with no regard to your assets.
SPDAP will pay (up to) $50 each month toward the premium in any Part D Drug Plan or Medicare Advantage Plan in Maryland.
How to Apply for SPDAP
To apply for SPDAP, call SPDAP at 1-800-551-5995 or go to MarylandSPDAP.com. Applications are available from SHIP. Call 301-255-4250 or download the Maryland SPDAP Application (PDF).
Maryland Senior Prescription Drug Assistance Program
c/o International Software Systems, Inc.
PO Box 749
Greenbelt, MD 20768-0749
Medicare Part D Premium Adjustment
In addition to the Part D plan premium, deductible and co-payments, those with incomes above $88,000 (individuals) and $176,000 (joint) pay an income-related premium adjustment.
| Individual Tax | Joint Tax | What enrollee pays for Part D premium |
| $88,000 or less | $176,000 or less | Premium only |
| $88,001-$111,000 | $176,001-222,000 | Premium + $12.30 |
| $111,001-$138,000 | $222,001-276,000 | Premium + $31.80 |
| $138,001-$165,000 | $276,001-330,000 | Premium + $51.20 |
| $165,001- $499,999 | $330,001-$749,999 | Premium + $70.70 |
| $500,000 or more | $750,000 or more | Premium + $77.10 |
** The additional monthly Part D income-related adjustment amount is not collected by the Medicare Part D plans, but instead directly deducted from Social Security, Railroad Retirement Board or the Office of Personnel Management benefits.
