Why Can’t Medicare Patients Use Coupons? (2024)

Zia Sherrell | November 28, 2023

The United States spent around $633.5 billion on prescription drugs in 2022. Experts believe that figure will continue to rise, with global spending predicted to climb by between 3% and 6% annually.

As we spend more on medications, it’s understandable that many are looking for ways to cut costs. Medicare prescription drug plans and prescription drug coupons are both great ways to save money on the medicines you need, but you can’t use Medicare benefits and coupons together.

Beneficiaries can get Medicare drug coverage in two ways:

• With a Medicare Part D prescription drug plan
• With a Medicare Advantage (Medicare Part C) plan that includes prescription drug coverage

In 2024, 89% of Medicare Advantage plans include prescription drug coverage.

Both types of Medicare drug coverage can help you save on your prescriptions. Some plans offer $0 drug deductibles or low copays for many generic drugs.

In this guide, we detail some of the ways you may be able to save money on your prescription medications, either through Medicare or through other drug discounts.

Can You Use Manufacturer Coupons With Medicare Coverage?

No, you can’t use manufacturer coupons at the same time as your Medicare benefits due to the Anti-Kickback Statute.

As part of the Social Security Amendments of 1972, this statute made it illegal for anyone to discount items or services paid for by a federal government healthcare program.

You can use a manufacturer coupon – such as a copay voucher – instead of your Medicare benefits, however. You might do this if the coupon would make your medications cheaper than they would be through your Medicare drug coverage.

However, comparing drug prices and calculating the potential savings can be challenging, as pharmacies are not always transparent about pricing options. Nevertheless, you can use online comparison tools to help you evaluate the costs of medications at various pharmacies in your locality and explore your options.

Can Medicare Part D Patients Use Discount Cards?

No, you can’t use Medicare Part D coverage and a discount card or coupon together. The same rule applies to Medicare Advantage plans with prescription drug coverage.

You should keep in mind that after your initial Medicare enrollment period ends (typically three months after the month of your 65^th birthday), it’s advised that you maintain either Medicare drug coverage or at least another type of insurance that is considered “creditable coverage” by Medicare. Creditable coverage is any prescription coverage that pays at least as much as standard Medicare drug coverage.

If you go 63 days or more without creditable drug coverage after your initial enrollment period ends, you’ll likely face late enrollment fees if you enroll in Medicare drug coverage in the future.

Can You Use GoodRx When You Have Medicare Part D?

GoodRx is a free program that negotiates deals with pharmacy benefit managers to secure low-priced medication for its members.

Since it’s a type of discount program, you can’t use GoodRx at the same time as your Medicare Part D coverage. The rule also applies to other popular discount cards such as Script Relief, SingleCare, and ScriptSave WellRx.

Can Medicare Patients Pay Cash for Prescriptions?

Paying cash is another possible option for saving money on your prescriptions. Instead of using your Medicare coverage, you can ask your pharmacist for a reduced cash price.

Bear in mind that the contracts pharmacies have with health insurance drug plans often prevent them from volunteering this information. Therefore, asking the pharmacist directly for the cash discount is the only way to secure the savings.

What Is the Medicare Coverage Gap Discount Program?

The Medicare Coverage Gap Discount Program is another way some beneficiaries of Medicare Part D or Medicare Advantage plans with drug coverage may be able to save money. Through the program, people in the Coverage Gap or “donut hole” who do not receive the Low Income Subsidy (LIS), also called Medicare Extra Help, can access manufacturer discounts from participating pharmacies.

If you and your Medicare drug plan combine to spend more than the Initial Coverage Limit ($5,030 in 2023) on your prescription medications, you enter what’s called the Coverage Gap, also referred to as the donut hole. While in the coverage gap, you typically pay a 25% coinsurance for your name brand and generic drugs until you spend your out-of-pocket limit.

Some people may exceed their true out-of-pocket limit (TrOOP) ($8,000 in 2024), meaning they enter the Catastrophic Coverage phase of Medicare Part D coverage. If you reach this coverage phase, you typically pay only a small coinsurance or copay for your drugs the rest of the year.

People with a fixed income may qualify for the Medicare Coverage Gap Discount Program. If you’re eligible, Medicare automatically enrolls you once you reach the coverage gap. Then, your insurance carrier applies the discount when the pharmacy bills them for your prescription. You’ll see your discount amount on your Explanation of Benefits.

Saving Money on Your Prescriptions Is Possible

Enrolling in a Medicare drug plan can be a great way to reduce the cost of your prescriptions, but it’s not your only option.

Discount cards and coupons can also help you save on the medications you need. While you can’t piggyback the savings from a coupon on top of your Medicare prescription drug plan, it’s always worth comparing the costs and finding the best choice to save you money.

You can also compare Medicare prescription drug plans online. If you find a plan that covers your drugs at a price you can afford, you may even be able to enroll in a plan online or call to speak with a licensed insurance agent who can answer your questions and help you enroll.