Help paying for your medication

Which program helps you depends on how you get your medicine

This is the sentence to take away, and almost nobody is told it plainly:

• If your medicine is an infusion or an office injection (Part B), the program that helps is QMB. Extra Help does nothing for it.
• If you inject yourself at home or take a pill (Part D), the program that helps is Extra Help.

People are handed an Extra Help application, get approved, and are told they are all set. Then the bill for the 20% of their infliximab arrives anyway. That is not a mistake by the plan and it is not a mistake on your bill. Extra Help is a Part D program. It was never able to touch a Part B drug.

What is QMB, and why does it matter so much for an infusion?

QMB is the program that pays your 20%. Its full name is the Qualified Medicare Beneficiary program. It is one of the Medicare Savings Programs, run through your state, and it covers your Part B premium, your Part B deductible, and the 20% coinsurance on every Part B drug. For someone on an infused biologic that is the entire bill.

There is a second protection that comes with it, and it is worth knowing because it is often ignored. Providers are legally forbidden from billing you for Medicare cost-sharing if you are in QMB. That applies whether you have Original Medicare or Medicare Advantage, and whether or not the provider takes Medicaid. If a bill comes anyway, they are required to withdraw it — including from a collection agency — and refund anything you already paid.

Two things about that table. First, only QMB pays the 20%. SLMB and QI pay your Part B premium and stop there, which is real money but does nothing about an infusion. Second, those are the federal minimums, and many states are more generous — some have raised the income limits, and some have removed the savings test entirely. If you are close, apply. Medicare’s own guidance says to apply even if your income or savings look too high.

And all three of them get you Extra Help automatically. QMB, SLMB and QI each put you into full Extra Help without a separate application. So the Medicare Savings Program is the one to apply for first: it is the only one that reaches a Part B drug, and it hands you the Part D help as well.

One honest note. QMB removes your liability completely, but because of how states settle up with Medicare, an infusion practice may collect little or nothing for the 20%. Some practices are reluctant about scheduling QMB patients on very expensive infusions for that reason. It is a known access problem, and it is not a reason to doubt the benefit or to skip applying — but if you meet resistance, that is probably what is behind it, and your state counselor has seen it before.

What is Extra Help, and what does it actually do?

Extra Help pays for the drugs you pick up yourself. It is the Part D Low-Income Subsidy. It brings your drug plan premium and your $615 deductible to zero, and it caps what you pay per prescription. Since 2024 there is no longer a partial version: you either get full Extra Help or you do not.

In 2026 the limits are about $23,940 a year for one person and $32,460 for a couple, with savings under $18,090 (or $36,100 for a couple), not counting your home or your car. Some income does not get counted, so the real cutoff is a little higher than those numbers — apply even if you are slightly over. The limits are higher than most people assume, and this is one of the most under-used programs in Medicare.

With Extra Help, a brand-name drug costs you $12.65 or less per prescription in 2026, and once you reach the $2,100 ceiling you pay nothing for the rest of the year. For a self-injected biologic that would otherwise run tens of thousands of dollars, that is the difference between taking it and not.

Apply through Social Security, by phone at 1-800-772-1213 or at ssa.gov/medicare/part-d-extra-help. It is free to apply and there is no penalty for being turned down.

Why your copay card stopped working

If you used a manufacturer copay card before you turned 65 and it stopped working the month you went on Medicare, nothing is wrong with your card and nothing is wrong with you.

Manufacturer copay cards cannot be used by anyone on Medicare. Federal law treats a drug company paying down your share of a federally covered prescription as an illegal inducement, so every card carries an exclusion for Medicare, Medicaid and other government coverage. It is not your plan being difficult and it is not something an appeal can fix.

This is the single most demoralizing surprise of the Medicare transition, and it is where most people stop looking. That is the mistake. Two other kinds of help exist, both are open to people on Medicare, and they are not the same thing as a copay card.

The two kinds of help that do work on Medicare

1. Independent charitable foundations

These are separate charities, not drug companies. Because they are genuinely independent of their donors, federal regulators permit them to help people on Medicare, and they do.

The thing to check first is whether the fund pays medical claims or only pharmacy claims. This decides everything for an infusion.

• PAN Foundation accepts claims from your doctor’s office for drugs given in a clinic, as well as pharmacy claims and direct reimbursement to you. For an infused biologic, this is the first place to look. panfoundation.org or 1-866-316-7263.
• HealthWell Foundation runs autoimmune and vasculitis funds, including a giant cell arteritis fund, and requires Part B. Its autoimmune assistance comes as a pharmacy card, so it fits a self-injected drug better than an infusion. healthwellfoundation.org or 1-800-675-8416.
• Patient Advocate Foundation Co-Pay Relief has rheumatoid arthritis and Sjögren’s funds and serves people on Medicare. copays.org. Ask specifically whether the fund you need covers a clinic-administered drug.

Income limits are generous — commonly three to five times the federal poverty level, adjusted for household size — so being turned away from something else does not mean you will be turned away here.

The part that matters most is the timing. These funds open and close as money runs out, sometimes within weeks. You cannot apply to a closed fund, but you can join its wait list, and your place in line is set by the day you signed up, not by how fast you answer when it reopens. When PAN reopens a fund it emails you a link, and you have two business days to use it before it expires.

So: join the wait list the day you find out a fund is closed, not the day you need the money. Use an email address you check daily. This one piece of housekeeping is worth more than anything else on this page.

2. The drug maker’s own assistance foundation

Separate from the copay card, most manufacturers run a foundation that provides the medication itself at no charge to people who qualify — and these generally do serve people on Medicare. The card and the foundation are different programs run by the same company, which is why “not valid with Medicare” on one does not mean the other is closed to you.

• Infliximab, golimumab — Johnson & Johnson Patient Assistance Foundation, jjpaf.org
• Rituximab, tocilizumab — Genentech Patient Foundation, (888) 941-3331
• Abatacept — Bristol Myers Squibb Patient Assistance Foundation, bmspaf.org
• Secukinumab — Novartis Patient Assistance Foundation, pap.novartis.com

Two practical notes. For an infusion, the free drug is usually shipped to your doctor’s office rather than to you, so the office has to take part — you cannot do this one alone. Ask them. And several of these programs want to see what you have already spent on medications, so keep your pharmacy receipts.

Spread the January bill instead of paying it all at once

If your medicine is a Part D drug, most of your $2,100 lands on the first fill or two of the year. Medicare has a program that spreads it across the remaining months of the year with no interest — the Medicare Prescription Payment Plan.

Be clear about what it does and does not do. It does not reduce what you owe. It changes when you pay it, and the bill comes from your plan rather than the pharmacy. If you qualify for Extra Help, take Extra Help instead — that actually lowers the amount. And sign up in December if you can, because enrolling in February does nothing about the charge you already paid in January.

medicare.gov/prescription-payment-plan

If you have been making the medicine last longer

Some people space their infusions out. Some skip a dose in January when the bill is worst. Some split tablets that were not meant to be split. Most do not mention it at the appointment.

If that is you, you are not unusual and you are not doing something shameful. In a national study of older adults with rheumatoid arthritis, about one in five reported skipping or reducing doses because of cost — roughly three and a half times the rate of people without a chronic condition. Some were also cutting back on food or heat to afford the prescription.

The reason to say it out loud is not confession, it is that stretching some of these drugs makes them stop working. Infliximab is the clearest example: given on and off rather than on schedule, your body is far more likely to build antibodies against it. In the trial that measured this, antibodies appeared in 30% of patients treated episodically against 10% on a regular schedule, and those antibodies mean more infusion reactions and a drug that gradually stops helping. The label warns specifically about gaps longer than 16 weeks. So a gap taken to save money can cost you the medication permanently — and then the next one is harder to get approved.

There is also a survey finding worth repeating to you. When Canadian researchers asked both sides, not one rheumatologist said they never discussed cost with patients — but 22% of the patients said they never had. Both groups thought it mattered. It just was not getting said. The authors concluded that patients may have to be the ones to start it.

So start it. Five words is enough: “I can’t afford this — what are my options?” There is usually more than one, and none of them work if nobody knows.

Who will help you apply, for free

These applications are not hard, but they are tedious, and a trained counselor will do them with you at no cost. They are paid nothing regardless of what you qualify for.

• Washington: SHIBA — insurance.wa.gov/shiba or 1-800-562-6900
• Any other state: SHIP — shiphelp.org
• Medicare Savings Programs — medicare.gov/basics/costs/help/medicare-savings-programs, or apply through your state Medicaid office
• If you are in QMB and a provider bills you anyway — call 1-800-MEDICARE. If a collection agency is involved, file with the Consumer Financial Protection Bureau at consumerfinance.gov/complaint or 1-855-411-2372. You have a right to a refund of anything you already paid.

Related

• Medicare and your medication — what your medicine costs under each kind of Medicare
• Why your medicine needs permission first
• Helping a parent with all of this

Where these figures come from

1. 2026 Medicare Savings Program income and resource limits — Medicare.gov, “Medicare Savings Programs”; National Council on Aging, 2026 MSP eligibility chart, March 2026. These are federal minimums; states may use more generous criteria.
2. QMB covers the Part B premium, deductible and coinsurance — Social Security Act §1905(p)(3), 42 U.S.C. §1396d(p)(3). Subparagraph (D) defines the benefit as the difference between payment at 80% and payment at 100% under §1833(a), which is the Part B coinsurance exactly.
3. Prohibition on billing QMB enrollees for Medicare cost-sharing, the duty to recall charges and refund payments, and the complaint routes — CMS, MLN7936176, “Prohibition on Billing Dually Eligible Individuals Enrolled in the QMB Program,” September 2025; CMS Product No. 12039, “3 Tips for People in the QMB Program,” revised May 2025. Statutory basis: Social Security Act §§1902(n)(3)(B) and (C), 1905(p)(3), 1866(a)(1)(A), 1848(g)(3)(A).
4. States may limit what they pay providers for QMB cost-sharing — Social Security Act §1902(n) as amended by §4714 of the Balanced Budget Act of 1997; Center for Medicare Advocacy analysis. The beneficiary owes nothing regardless.
5. QMB, SLMB and QI enrollees are deemed eligible for the full Part D low-income subsidy without applying — 42 CFR §423.773(c).
6. 2026 Extra Help resource limits ($18,090 individual, $36,100 married, including the burial exclusion) and 2026 cost-sharing ($5.10 generic / $12.65 brand for most applicants; $0 above the $2,100 threshold) — CMS, “Resource Limits for the Medicare Part D Low-Income Subsidy: Annual Adjustment for CY 2026,” October 31, 2025. Income limits of $23,940 and $32,460 are 150% of the 2026 federal poverty guidelines — Medicare.gov; 91 FR 1797, January 15, 2026. Some income is disregarded, so the effective limit is slightly higher.
7. Extra Help is a Part D benefit only and does not apply to drugs covered under Part B — Social Security Act §1860D-14; 42 CFR Part 423, Subpart P. The partial subsidy was eliminated for plan years beginning January 1, 2024 — 42 CFR §423.773(b).
8. Manufacturer copayment coupons may not be used by federal healthcare program beneficiaries — HHS Office of Inspector General, “Special Advisory Bulletin: Pharmaceutical Manufacturer Copayment Coupons,” September 2014; Anti-Kickback Statute, 42 U.S.C. §1320a-7b(b); Beneficiary Inducements CMP, 42 U.S.C. §1320a-7a(a)(5).
9. Independent charitable patient assistance programs may serve Medicare beneficiaries when genuinely independent of donors — HHS Office of Inspector General, “Supplemental Special Advisory Bulletin: Independent Charity Patient Assistance Programs,” May 2014, supplementing the November 2005 bulletin.
10. PAN Foundation accepts provider-submitted claims for physician-administered drugs; wait list queue position is set by original signup date and applicants have two business days to respond when a fund reopens — PAN Foundation, “Submitting claims” and “Wait lists.” HealthWell’s autoimmune Medicare access fund provides a pharmacy card — HealthWell Foundation disease fund pages. Fund status changes frequently; check before relying on it.
11. Cost-related medication nonadherence in older adults with rheumatoid arthritis (18.4% to 20.7% prevalence; odds ratio 3.52 versus people with no chronic condition; odds ratio 2.41 for spending less on basic needs) — Harrold LR, Briesacher BA, Peterson D, et al., Journal of Rheumatology 2013;40(2):137–43, using Medicare Current Beneficiary Survey data from 2004–2008 (n=1,100 with rheumatoid arthritis). These data predate the Part D out-of-pocket cap.
12. Antibodies to infliximab in 30% of patients given episodic treatment versus 10% on scheduled maintenance — Hanauer SB, Wagner CL, Bala M, et al., Clinical Gastroenterology and Hepatology 2004;2(7):542–53. Higher rates of antibodies after drug-free intervals longer than 16 weeks, and their association with reduced efficacy and infusion reactions — Remicade prescribing information, revised February 2025. Both describe Crohn’s disease populations; the mechanism is a property of the drug.
13. Patient and rheumatologist reporting on cost conversations (22% of patients reported never discussing cost; no rheumatologist reported never discussing it) — Kaal KJ, Bansback N, Hudson M, Anis A, Koehn C, Harrison M, Clinical Rheumatology 2020;40(1):93–100. A Canadian online survey of 78 patients and 64 rheumatologists, not a population estimate.
14. Medicare Prescription Payment Plan — CMS, medicare.gov/prescription-payment-plan.

About this page

Written and reviewed by Alison Bays, MD, MPH, board-certified rheumatologist. Figures are current for 2026 and were last checked in September 2026.

This is educational information, not advice — not medical, legal, financial or insurance advice, and not a substitute for talking to your doctor, your plan, or a benefits counselor. Nothing is sold here. No insurance is sold here, no plan is recommended, and neither this page nor its author is paid by any insurance company, plan, pharmaceutical manufacturer, foundation or broker. This page is not affiliated with, endorsed by, or connected to Medicare, the Centers for Medicare & Medicaid Services, or any government agency.

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