Understanding Prescription Discount Programs & Medicare
- 5 days ago
- 2 min read
When a Lower Price May Not Actually Save You Money
Prescription costs continue to be one of the biggest concerns among Medicare Beneficiaries. Today, more than half of adults 65 and older (54%) report taking four or more prescription drugs (KFF).
Even with recent changes designed to improve affordability, searching for ways to lower costs at the pharmacy remain.
If you've been to a pharmacy in the last decade, you've heard of GoodRx, SingleCare, or Cost Plus Drugs: free discount programs that are designed to find the lowest price for prescriptions.
We're not going to get into how these programs work, but instead how to use them alongside your Medicare Advantage (Part C) or Prescription Drug Plan (Part D).
The Important Medicare Tradeoff
When you use a discount program like GoodRx, that purchase does not count toward your Medicare prescription spending progress (Deductibles and Maximum Out of Pockets (MOOPs).
Beginning in 2025, ALL Medicare Plans with prescription drug coverage (Medicare Advantage & Standalone Prescription Drug Plans) introduced annual limits on covered prescription spending.
In 2026, this annual limit is $2,100. Upon hitting the cap, all covered prescriptions cost $0 for the remainder of the calendar year.
This creates scenarios where the "cheapest" price today is not the cheapest for the year.
Example: Lower Today vs. Lower for the Year
Imagine someone is taking a high-cost brand name medication that they fill every month. Something like Eliquis, Jardiance, or Xarelto.
Scenario A: Using A Discount Program
GoodRx Price: $400/month
12 months of refills - $5,400 annual cost
Amount applied to Medicare Deductible/MOOP - $0
Scenario B: Using Medicare Prescription Coverage
Medicare Plan Cost: $600/month initially
Spending accumulates toward the annual Maximum Out of Pocket ($2,100 in 2026)
Once the annual limit is reached, ALL covered prescriptions become $0 for the remainder of the calendar year
$2,100 annual cost
The Medicare price may look worse initially, but over the course of a year, reaching the annual spending cap provides a much smaller annual cost ($5,400 vs. $2,100).
NOTE: Medicare Plan Deductibles and MOOP reset every calendar year (January 1).
Finding the Right Strategy Matters
So what's the moral of the story? Understand both your Medicare Plan and Discount Programs to determine the lowest cost.
There are plenty of scenarios where GoodRx & Co. provide someone with a lower cost than what their Medicare Plan provides, but it's not always that simple.
Sometimes using GoodRx makes sense.
Sometimes using your Medicare coverage makes sense.
Sometimes the answer is a combination of both.
At Seniority Benefit Group, helping clients lower prescription costs goes beyond simply comparing monthly premiums. We help evaluate medications, formularies, pharmacy options, and available cost-saving strategies to determine what makes the most sense for each person's situation.
If you're weighing prescription costs across several Discount Programs and your Medicare Plan, let Seniority Benefit Group be your resource!
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