💊 How to Use GoodRx with Medicare Advantage

Learn when cash prices with discount programs can be cheaper than using your Medicare coverage

30-50%

Potential Additional Savings

65M+

Medicare Beneficiaries

Legal

To Use Both Options

💡 The Little-Known Medicare Strategy

Here's what most Medicare Advantage members don't know: You can choose to pay cash with discount programs like GoodRx instead of using your Medicare coverage when it saves you money. This is completely legal and sometimes results in significant savings.

Many Medicare Advantage plans have high copays for certain medications, especially in the deductible phase or for non-preferred drugs. In these cases, using a discount program might cost less than your Medicare copay.

🔍 Important Legal Fact

You are never required to use your Medicare coverage. You always have the right to pay cash for your prescriptions, and using discount programs like GoodRx is completely legal even if you have Medicare.

⚖️ When Cash Prices Beat Medicare Copays

Here are common scenarios where paying cash with GoodRx might be cheaper than using your Medicare Advantage coverage:

Scenario	Medicare Advantage Cost	GoodRx Cash Price	Best Choice
Generic in Deductible Phase Lisinopril 10mg (30 tablets)	$45 (full cost until deductible met)	$8 with GoodRx	Use GoodRx
Non-Preferred Brand Drug Nexium 40mg (30 capsules)	$85 copay (Tier 3)	$45 with GoodRx	Use GoodRx
Specialty Medication High-cost injection	$200 copay (Tier 4)	$125 with manufacturer coupon	Use Manufacturer Program
Preferred Generic Metformin 500mg (90 tablets)	$5 copay	$15 with GoodRx	Use Medicare

📋 How to Compare Prices and Choose the Best Option

Check Your Medicare Plan's Formulary

Look up your medication on your plan's drug list (formulary) to see what tier it's on and what your copay will be. This information is available on your plan's website or by calling customer service.

Get GoodRx Price Quote

Visit GoodRx.com or use their app to search for your medication. Enter the exact strength, quantity, and your zip code to see cash prices at nearby pharmacies.

Compare Total Costs

Compare your Medicare copay to the GoodRx cash price. Don't forget to factor in whether you've met your deductible and if the medication counts toward your out-of-pocket maximum.

Choose at the Pharmacy

At the pharmacy, you can decide which option to use. Tell the pharmacist "I want to pay cash with this discount" and show your GoodRx coupon, or use your Medicare card for coverage.

Track Your Spending

Keep records of what you pay. Cash payments with discount programs don't count toward your Medicare deductible or out-of-pocket maximum, which may affect your decision.

⚠️ Important Things to Know

⚠️ Cash Payments Don't Count Toward Medicare Benefits

When you pay cash with discount programs, those payments don't count toward your Medicare deductible or out-of-pocket maximum. This means you might pay more later in the year when you reach the coverage gap.

📱 Use Technology to Your Advantage

Apps like GoodRx, SingleCare, and pharmacy-specific apps can help you quickly compare cash prices. Many pharmacies also have their own discount programs that might beat both Medicare and third-party discounts.

💰 Best of Both Worlds Strategy

Use Medicare for medications with low copays and discount programs for expensive medications with high copays. This hybrid approach can maximize your savings throughout the year.

📊 Real-World Examples

Example 1: Sarah's Diabetes Medications

Sarah has Medicare Advantage with a $400 deductible. In January, her metformin costs $45 through Medicare (deductible phase) but only $8 with GoodRx. She saves $37 by using GoodRx for the first few months until her deductible is met.

Example 2: Robert's Heart Medication

Robert's Eliquis has a $75 copay on his Medicare plan (Tier 3). With a manufacturer coupon, he pays only $10. He saves $65 per month by not using his Medicare coverage for this medication.

Example 3: Maria's Generic Prescriptions

Maria's plan covers most generics for $5 copays. GoodRx prices are typically $10-15 for the same medications. She uses her Medicare coverage because it's consistently cheaper.

Need Help Optimizing Your Medicare Drug Costs?

As a licensed insurance professional, I can help you analyze your specific medications and Medicare plan to create a personalized cost-saving strategy that maximizes your savings year-round.

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