Montana's Big Sky Rx pays up to $50.60 a month in 2026 toward the premium on a Medicare-approved prescription drug plan. The Montana Department of Public Health and Human Services runs Big Sky Rx for Montana residents on Medicare whose 2026 income is under $31,920 for a single person or $43,280 for a married couple living together. You can apply for Big Sky Rx at any time of the year.

In This Guide

What Big Sky Rx Pays For

Big Sky Rx (the state abbreviates it BSRx) is Montana's Medicare Part D State Pharmaceutical Assistance Program. The Montana Department of Public Health and Human Services administers Big Sky Rx to help Medicare clients pay for Medicare-approved prescription drug insurance premiums.

For 2026, Big Sky Rx can pay up to $50.60 per month toward the premium on a qualified individual's prescription drug plan, a ceiling Montana's health department sets by rule rather than a fixed check. The practical question is how your own plan's monthly premium compares against that ceiling. Pull up your Part D plan's premium before you apply and you'll know roughly what Big Sky Rx can absorb.

The 2005 Montana Legislature passed Senate Bill 324, which created four prescription-drug affordability programs funded by the state's tobacco tax revenue; Big Sky Rx is the piece of that bill aimed at Medicare drug plan premiums. Federal regulation at 42 CFR 423.464(e)(1) defines a State Pharmaceutical Assistance Program and specifically excludes state Medicaid programs, section 1115 demonstration programs, and any other program whose funding comes from federal grants, awards, contracts, entitlement programs, or other federal sources, so a federally funded program cannot hold that status.

The statute behind Big Sky Rx is Montana Code Annotated (MCA) 53-6-1004, which directs the state health department to run a "pharmacy access prescription drug benefit program" that contributes to the cost of the Part D premium and, optionally, to the cost of the deductible. In practice Montana has built Big Sky Rx as premium assistance. MCA 53-6-1004 also leaves both the income standard and the dollar amount of the premium benefit to Montana department rule, set against enrollment numbers and the available appropriation, which is why the $50.60 figure is worth re-checking each year rather than assuming it holds.

Do You Qualify for Big Sky Rx?

Montana's Big Sky Rx test is short, and an applicant has to meet every part of it.

Requirement What Big Sky Rx looks at
Residency Montana is your primary state of residence
Medicare You must be a Medicare recipient
Income, single person Less than $31,920
Income, married and living together Less than $43,280
Assets IRAs, bonds, stocks, and savings accounts are not counted as income
Drug plan MCA 53-6-1004 requires proof of enrollment in a Part D prescription drug plan

Montana's $43,280 Big Sky Rx limit is written for spouses who live together, not for anyone who is married.

Montana does not count a nest egg as income for Big Sky Rx, so a savings balance on its own does not put you over the limit.

Behind Montana's published numbers sits a statutory ceiling. MCA 53-6-1004 caps Big Sky Rx eligibility at a family income of up to 200% of the federal poverty guidelines, which the federal government resets each year. That is why the dollar limits move. If you're reading this late in the year and you're close to the line, check the current numbers on the Big Sky Rx program page before you decide you are over.

How Big Sky Rx Works With Your Part D Plan

Big Sky Rx does not replace Medicare Part D. Big Sky Rx sits on top of a Part D plan, and MCA 53-6-1004 requires proof that you are enrolled in one before Montana's program will help. You pick a drug plan first, then Big Sky Rx helps carry its premium.

The payment order is fixed by federal rule. 42 CFR 423.464(b) provides that "a Part D plan is always the primary payer relative to a State Pharmaceutical Assistance Program." Your plan adjudicates each prescription at the counter; Big Sky Rx's help sits behind it, on your monthly premium.

Under the definition of "incurred costs" at 42 CFR 423.100, what a State Pharmaceutical Assistance Program pays toward the deductible and cost-sharing on your covered Part D drugs counts among the incurred costs Medicare uses to decide whether you have reached your annual Part D out-of-pocket threshold. For 2025 and subsequent years, costs reimbursed through insurance, a group health plan, or certain other third-party payment arrangements count toward that threshold as well; what does not count is the basic drug coverage your own Part D or Medicare Advantage drug plan provides, or a manufacturer's payments under the Manufacturer Discount Program. Big Sky Rx describes itself as a State Pharmaceutical Assistance Program, but what Big Sky Rx pays is the premium on your Montana Part D plan rather than drug cost-sharing, so your progress toward that threshold still runs through what you pay at the pharmacy counter.

For the general mechanics of how these state programs and Part D fit together, our national guide to State Pharmaceutical Assistance Programs covers the pattern across states.

Can You Switch Part D Plans Anytime?

Montana tells Big Sky Rx clients that because the program is a State Pharmaceutical Assistance Program, they may enroll in a prescription drug plan at any time of the year, or change plans once a year.

The federal rule behind that sits at 42 CFR 423.38(c)(17), under which a member of a qualified State Pharmaceutical Assistance Program "is eligible to make one enrollment election per year." If you use that election in March to move to a cheaper plan, this special enrollment period won't let you move again in September.

If you lose eligibility for Big Sky Rx, the federal special enrollment period stays open for an additional two calendar months after either the month your eligibility ends or the month you are notified, whichever is later. That's your window to line up other coverage.

Big Sky Rx and Extra Help: What the Statute Says

MCA 53-6-1004 describes the Big Sky Rx income test as applying to an individual with a family income of up to 200% of the federal poverty guidelines who is not eligible for federal low-income assistance under Part D. Federal low-income assistance under Part D is the program most people know as Extra Help, the Part D Low-Income Subsidy run through Social Security.

Extra Help is the application to make first if you think you might qualify for it, since MCA 53-6-1004 puts Big Sky Rx on the other side of that line. If you don't qualify for Extra Help, Big Sky Rx is written for exactly your position: a Montana Medicare recipient with modest income who falls outside the federal subsidy. When you are unsure which side of the line you are on, ask Big Sky Rx directly rather than guessing your way out of an application.

Montana's State Health Insurance Assistance Program (SHIP) offers free Medicare counseling, and a Montana SHIP counselor can look at your income, your current drug plan, and both programs at once.

How to Apply for Big Sky Rx, Step by Step

Big Sky Rx applications go in online or by mail.

  1. Confirm your Part D plan. MCA 53-6-1004 requires proof of enrollment in a prescription drug plan for the Part D Medicare benefit before Big Sky Rx will pay, so have your plan name and member number in front of you.
  2. Gather your income figures. Big Sky Rx checks your income against the Montana limits in the eligibility table above, so have those figures ready for yourself and, if you are married and living together, your spouse.
  3. Apply online, or get a paper form. Montana offers an online Big Sky Rx application. If you'd rather use paper, call (866) 369-1233 or download the application from the program page.
  4. Complete, sign, and mail it. A paper application has to be filled out in full, signed, and mailed to Big Sky Rx. The phone number above gets you an application; it's not a way to file one.

Not sure whether Big Sky Rx or Extra Help fits your situation? Chat with Brevy's care navigator at brevy.com.

Frequently Asked Questions

What are the income limits for Big Sky Rx?

Montana's 2026 Big Sky Rx limits are income less than $31,920 for a single person, or less than $43,280 for a married couple living together. Big Sky Rx measures income only; Montana does not count savings or investments against the limit.

Can I get Big Sky Rx and Extra Help at the same time?

Montana's Big Sky Rx statute, MCA 53-6-1004, writes the eligibility element for an individual who is not eligible for federal low-income assistance under Part D, which is Extra Help. Apply for Extra Help first if you might qualify, then ask Big Sky Rx or a Montana SHIP counselor how your specific situation is treated.

Does Big Sky Rx help with my drug copays and deductible?

Montana's published Big Sky Rx benefit is premium help, up to $50.60 a month in 2026 toward your drug plan's premium. MCA 53-6-1004 lets the department optionally set a portion of the deductible by rule, but what Montana's health department publishes for Big Sky Rx is the premium benefit alone, so plan on your copays and deductible staying on your plan's terms. Your copays and deductible on covered Part D drugs are among the costs that carry you toward the Part D out-of-pocket threshold.

Will Big Sky Rx cover my whole Part D premium?

Only if your plan's premium is $50.60 a month or less. That figure is the ceiling Montana sets on what Big Sky Rx pays toward a qualified individual's prescription drug plan premium in 2026, so a costlier plan leaves you the difference to pay.

Learn More

MedicareState Pharmaceutical Assistance Programs: How States Help Pay Drug CostsThirteen states run a State Pharmaceutical Assistance Program (SPAP) that helps pay Medicare Part D drug costs. See which states, and how a SPAP works. MedicareMedicare Plans and Coverage in MontanaMedicare in Montana for 2026: Parts A and B, Medicare Advantage, Part D, Medigap, MSP income limits, and free SHIP counseling through Montana DPHHS. MedicareHow Medicare Part D WorksMedicare Part D in 2026: a $2,100 out-of-pocket cap, no donut hole, three benefit phases, the $615 deductible, premiums, the late penalty, and Extra Help. MedicareMedicare Extra Help: The Part D Low-Income SubsidyMedicare Extra Help can cut Part D drug costs to a few dollars a prescription. See 2026 income and resource limits, what it pays, and how to apply. MedicareMedicare Savings Programs: Help Paying Premiums and CostsMedicare Savings Programs help low-income enrollees pay Part B premiums and, with QMB, all cost-sharing. See the four MSPs, 2026 limits, and how to apply. MedicarePennsylvania PACE and PACENET: How the State Helps Pay Your Medicare Drug CostsPennsylvania's PACE and PACENET help residents 65 and older pay Medicare Part D drug costs. See the 2026 income limits, no asset test, and how to apply.

Find personalized help sorting out Big Sky Rx and your Medicare Part D coverage in Montana at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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