Under 65 on Medicare? State Drug Assistance Programs That Take You

Seven state drug assistance programs have written rules that include people under 65 on Medicare, so being younger than 65 doesn't automatically rule you out. If you're on Medicare because of a disability or kidney failure and keep hearing that state help with prescriptions is "for seniors," the rules in New Jersey, Delaware, Rhode Island, Maine, Massachusetts, Vermont and Montana say otherwise, each in its own words, though Massachusetts stopped accepting new applications after September 11, 2026. Pennsylvania, New York, Wisconsin and Indiana are the four whose programs start at 65.1,2,3,4,5,6

In This Guide

• Which State Drug Programs Take People Under 65?
• Start With How You Got Medicare
• The Seven State Drug Assistance Programs With an Under-65 Door
• The Four Programs That Start at 65
• Maryland and Missouri: Ask the Program
• If Your State Isn't on This List
• Frequently Asked Questions
• Learn More

Which State Drug Programs Take People Under 65?

If you're under 65 and on Medicare, searching for a state drug assistance program can feel like reading signs that weren't written for you. Many program names include words like "Elderly" or "Senior." But a name isn't an eligibility rule, and the written rules in seven states make room for people under 65 who have a disability. A State Pharmaceutical Assistance Program, as federal rules define it, can base its help on financial need, age or medical condition.7

Brevy covers 13 state programs that help with prescription drug costs, most of them working alongside Medicare Part D coverage. The table below shows, for each one, whether its rules open a door before 65 and what that door asks of you.1,2,3,4,5,6,8,9,10,11

Start With How You Got Medicare

This is the part that trips people up, so it's worth slowing down. Being on Social Security disability and being on Medicare are not the same thing, and the states write their under-65 tests in different terms. Which states fit you depends on the road that brought you to Medicare.

People under 65 get Medicare through a disability or through End-Stage Renal Disease (ESRD), according to Medicare.gov.12

If you have Medicare because you get Social Security disability

For someone under 65, Medicare based on disability begins with the 25th month of Social Security Disability Insurance (SSDI) benefit entitlement, and people with ALS don't wait at all: they're entitled to Part A the first month they're entitled to disability cash benefits.12 Once you have that Medicare, you meet the age-or-disability part of the rules in New Jersey, Delaware and Rhode Island (Rhode Island from 55), which ask whether you receive Social Security disability benefits.1,2,3 Medicare through Social Security disability also meets Vermont VPharm's under-65 disability definition and Montana Big Sky Rx's eligibility rules, which list no age limit.5,6 Every other condition in those states (income, residence, a drug plan) still applies.

If you have Medicare because of kidney failure, without SSDI

Medicare through ESRD is available at any age, but only when its own conditions are met: kidneys that no longer work, regular dialysis or a kidney transplant, and a work-record or family condition, such as having worked the required time under Social Security or being the spouse or dependent child of someone who has.12 If that's your situation:

• Vermont VPharm counts Medicare eligibility on its own: Vermont's law defines a person with disabilities as someone under 65 who gets Social Security disability insurance benefits or is eligible for Medicare.5
• Montana Big Sky Rx lists residence, Medicare, a Part D plan and income in its eligibility rules, and none of those is an age limit.6
• New Jersey, Delaware and Rhode Island write their under-65 test as receiving Social Security disability benefits, so Medicare through kidney failure alone doesn't match their wording as written.1,2,3 That isn't the same as a no. Call the program and ask how it treats your situation before you rule yourself out.

Our guide to how Medicare covers kidney disease explains the ESRD route in more detail.

If you get SSDI but are still waiting for Medicare

The months between your first disability check and the start of your Medicare coverage are hard ones, and the drug programs that key on Medicare can't fill that gap. Vermont VPharm's rules require Medicare Part A or Part B and a Medicare Part C or D plan, so disability benefits without Medicare don't meet them.5 Montana Big Sky Rx requires proof that you're enrolled in a Part D plan.6 For New Jersey, Delaware and Rhode Island, ask the program directly what it can do while you wait. Our guide to getting Medicare under 65 through disability walks through the waiting period.

The Seven State Drug Assistance Programs With an Under-65 Door

Each state below writes its own test, and the help behind it isn't the same size everywhere: it runs from a share of the cost of a few generic drugs to covering your Part D premium. Read each one for what it would actually do for you, not just whether you can get in.3,13 The income figures are 2026 amounts, so confirm the current numbers with the program when you apply.

New Jersey: PAAD and Senior Gold

New Jersey's Pharmaceutical Assistance to the Aged and Disabled (PAAD) program takes applicants between 18 and 64 who receive Social Security Title II Disability benefits, and the Senior Gold Prescription Discount Program takes applicants at least 18 who receive Social Security disability benefits. In 2026, New Jersey PAAD's income limit is less than $54,943 single or less than $62,390 married, and Senior Gold covers incomes from $54,943 to $64,943 single or $62,390 to $72,390 married. Medicare-eligible PAAD members must enroll in a Part D plan. If your income lands just above New Jersey PAAD's line, that isn't the end of it: Senior Gold's range starts where PAAD's stops, so you'd move up a tier rather than out.1 Read our full New Jersey PAAD and Senior Gold guide.

Delaware: DPAP

The Delaware Prescription Assistance Program (DPAP) takes Delaware residents under 65 who receive Social Security Disability benefits; the state statute words it as ages 19 to 64 and otherwise eligible for Title II Social Security benefits. Delaware DPAP's income test is 200% of the federal poverty level, which the 2026 table from Delaware's Division of Medicaid and Medical Assistance (DMMA) sets at $2,660 a month in countable income for one person and $3,607 for two, or you can qualify if your prescription costs exceed 40% of your income. Delaware DPAP pays up to $3,000 a year toward drugs and Part D premiums, and a Medicare-eligible member must show proof of Part D enrollment within 90 days of benefits starting. The 40% route is the one to know if your prescriptions eat a large share of a modest disability check, because it can open Delaware DPAP even when your income is over the 200% line. Delaware DPAP members still pay a co-payment of 25% of each prescription's cost, or $5 at minimum.2 See our Delaware DPAP guide.

Rhode Island: RIPAE, from age 55

Rhode Island Pharmaceutical Assistance to the Elderly (RIPAE) takes Rhode Islanders who are at least 55 and receive Social Security disability benefits. Rhode Island RIPAE places disabled adults ages 55 to 64 in income level 4 only: in 2026, income must be $85,848 or less, and the state pays 15% of the cost of approved generic drugs bought during the Part D deductible stage while the member pays 85%. Rhode Island RIPAE members must be enrolled in a Part D or Medicare Advantage drug plan and cannot be enrolled in Medicaid or Extra Help. For someone 55 to 64, that's narrow help, and Rhode Island RIPAE pays it back to you rather than to the pharmacy, at least quarterly. It's most worth applying for if generics during your deductible stage are a real strain.3 If you're under 55, Rhode Island RIPAE's written rules don't include you. Read our Rhode Island RIPAE guide.

Maine: DEL, ages 19 to 61

Maine's Low Cost Drugs for the Elderly or Disabled (DEL) program takes people age 19 through 61 who meet the Supplemental Security Income (SSI) disability criteria, and anyone 62 or older without a disability test. Maine DEL asks whether you meet the SSI disability criteria, not whether you receive SSI. Maine DEL's income limit is 185% of the federal poverty level, with no asset test since January 1, 2024, and someone eligible for Part D must enroll in a Part D plan at the next opportunity. What it means at the pharmacy: for drugs on Maine DEL's basic list, which covers conditions such as diabetes, heart conditions, high blood pressure and multiple sclerosis, your cost can't exceed $2 plus 20% of the price the program allows for that drug. And if Maine DEL turns you down, you can ask for a hearing.3 Our Maine DEL guide has the details.

Massachusetts: Prescription Advantage

Massachusetts Prescription Advantage has a disability track for people under 65 in its rules, but the program stopped accepting new applications after September 11, 2026. If you're already enrolled, your participation continues.4 Under 651 CMR 15.04, Prescription Advantage's disability track is for a Massachusetts resident under 65 with gross annual household income at or below 188% of the federal poverty level, no more than 40 hours of work a month, and the MassHealth CommonHealth disability requirements. An under-65 applicant to Massachusetts Prescription Advantage can't have income above $30,005 single or $40,683 married and must document the disability. Massachusetts Prescription Advantage members can't be eligible for MassHealth or enrolled in a MassHealth Buy-In program. That under-65 line sits far below the 500%-of-poverty limit people 65 and older with Medicare face.4 If you have Medicare, Massachusetts Prescription Advantage also requires a Medicare Part D plan or a creditable drug plan.14 See our Massachusetts Prescription Advantage guide. Because Massachusetts Prescription Advantage isn't taking new applications, someone under 65 who isn't already a member should start with the other help in the section on what to do if your state isn't listed.4

Vermont: VPharm

Vermont law opens VPharm to a person with disabilities, defined as someone under 65 who gets Social Security disability insurance benefits or is eligible for Medicare. Vermont's VPharm rules apply the disability track to people who are under 65 when coverage starts, have Medicare Part A or Part B, and have a Medicare Part C or D plan; the other conditions (Vermont residence, an income limit, no other private drug insurance, not on Medicaid) still apply.5 Vermont VPharm's household income limit is 225% of the federal poverty level, with monthly premiums of $15, $20 or $50 per person depending on income in 2026. For that premium, Vermont VPharm pays the Part D premium for the standard drug benefit (though not late-enrollment penalties), and your own co-payment is $1 a prescription when the Part D cost-sharing is under $30, or $2 when it's $30 or more.13 Read our Vermont VPharm guide.

Montana: Big Sky Rx

Montana's Big Sky Rx eligibility rules list Montana residence, Medicare, enrollment in a Part D plan and income at or below 200% of the federal poverty level, and none of them is an age limit. People on Medicaid or getting Extra Help with a full premium subsidy can't use Montana Big Sky Rx at any age, and the program isn't an entitlement: Montana may reduce enrollment if funding runs short.6 In 2026, Montana Big Sky Rx can pay up to $50.60 a month toward your Part D premium, for incomes under $31,920 single or $43,280 for a married couple living together. That's help with the premium, not with copays at the counter. If your income is under those figures and your assets are limited, Montana sends you to apply for Extra Help first and to send Big Sky Rx a copy of Social Security's decision, so start that application early.15 See our Montana Big Sky Rx guide.

The Four Programs That Start at 65

If you live in one of these states, it's frustrating to find that the state's drug program won't take you yet. Their written rules set 65 as the floor:

• Pennsylvania PACE/PACENET (the Pharmaceutical Assistance Contract for the Elderly): Pennsylvania's PACE/PACENET programs are for residents 65 and older.8
• New York EPIC: New York EPIC members must be 65 or older.9
• Wisconsin SeniorCare: Wisconsin SeniorCare enrollees must be 65 or older.10
• Indiana HoosierRx: Indiana HoosierRx applicants must be 65 or older.11

That doesn't leave you without options. The federal and state programs in the section on what to do if your state isn't listed are where to turn next.

Maryland and Missouri: Ask the Program

Two programs don't fit neatly into yes or no.

Maryland runs the Senior Prescription Drug Assistance Program (SPDAP). We haven't confirmed SPDAP's age rule from a state source we can cite, so if you're under 65 in Maryland, contact SPDAP directly and ask. Our Maryland SPDAP guide covers how the program works.

The Missouri Rx Plan (MORx), run by the Missouri Department of Social Services, works differently from the others. Missouri residents enrolled in both Medicare and MO HealthNet are deemed enrolled in MORx automatically, and a member who no longer meets the MO HealthNet or Medicare requirements is dropped.3 The door to Missouri MORx is MO HealthNet, so ask MO HealthNet about your eligibility. Our Missouri MORx guide explains the rest.

If Your State Isn't on This List

If you don't live in one of the 13 states above, or your state's program starts at 65 or, like Massachusetts, isn't taking new applications, that can feel like one more door closing.4 It isn't the end of the road. Federal Extra Help, the Part D Low-Income Subsidy, helps pay Part D premiums, deductibles and copayments for people with limited income; our Extra Help guide explains who qualifies.16 Medicare Savings Programs are state-run, Medicaid-administered programs that help people with limited income and resources pay Medicare costs; see our Medicare Savings Programs guide.17 And your State Health Insurance Assistance Program (SHIP) gives free, personalized counseling to people with Medicare and their families; our guide to free SHIP counseling explains what to expect.18

Learn More

Find personalized help sorting out which state drug program takes you before 65 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.