Big Sky Rx: Montana's Prescription Drug Premium Help for Medicare

What Big Sky Rx Actually Pays For

Big Sky Rx is Montana's State Pharmaceutical Assistance Program, run by the DPHHS Senior and Long Term Care Division in Helena. It pays up to $50.60 per month toward your Medicare Part D or Medicare Advantage drug plan premium — that comes to $607.20 a year off your prescription drug costs.

The program covers premiums only. It does not pay Part D deductibles, copayments, coinsurance, or late enrollment penalties. If your drug plan premium is under $50.60, Big Sky Rx pays the full premium. If it's higher, the program pays $50.60 and you cover the rest.

Big Sky Rx also works as a payer of last resort. If Extra Help already covers 100% of your benchmark premium, Big Sky Rx pays nothing additional. If Extra Help covers only part of the premium, Big Sky Rx picks up the remaining balance up to $50.60.

2026 Income Limits and the No-Asset-Test Rule

Big Sky Rx has two features that set it apart from the Medicare Savings Programs:

• No asset test. Bank accounts, investments, home equity — none of it counts. Eligibility runs on income alone.
• Higher income ceiling. Individuals earning under $31,920 per year ($2,660/month) and couples earning under $43,280 per year ($3,606.66/month) qualify. That's 200% of the federal poverty level, well above the QMB or SLMB thresholds.

The program uses gross household income — Social Security, pensions, wages, investment income — without the $20 disregard that MSP calculations use.

How to Apply

You can apply year-round through two channels:

1. Online at BigSkyRx.MT.gov
2. By mail using Form BSRx-002, sent to: Big Sky Rx Program, PO Box 202915, Helena, MT 59620-2915

You'll need proof of Montana residency, your Medicare card showing Part A and/or Part B enrollment, evidence that you're enrolled in a Medicare Part D or MA-PD plan, and income documentation (Social Security award letter, pension statements, or tax returns).

The Big Sky Rx helpline is 1-866-369-1233 if you need to check on a pending application or ask about eligibility.

The Extra Help Sequencing Trap

Here's where applications stall: if your income falls at or below 150% of the federal poverty level ($1,816/month for an individual), Big Sky Rx requires you to apply for Social Security Extra Help first and submit your SSA decision letter — approval or denial — with your Big Sky Rx application.

State records show that over half of pending Big Sky Rx applications sit in limbo because applicants didn't attach their Extra Help determination. The program sends a notice explaining this requirement, but many families miss it or don't understand what's being asked.

What to do: Apply for Extra Help at ssa.gov/medicare/part-d-extra-help or call Social Security at 1-800-772-1213. Once you get the decision letter, attach a copy to your Big Sky Rx application or fax it to the Senior and Long Term Care Division. If your income is above 150% FPL, you can skip this step entirely.

What Happens After Approval

Big Sky Rx pays the subsidy directly to your Part D plan — you don't receive a check. Your monthly drug plan statement will reflect the reduced premium. Follow any renewal instructions you receive, and report income or address changes promptly to avoid coverage interruptions.

If you're denied, the notice will explain why. The most common reason is income above the limit. If your income has since dropped (lost a pension, spouse passed away), you can reapply immediately with updated documentation.

For help choosing the right Part D plan to pair with Big Sky Rx, contact Montana SHIP at 1-800-551-3191 — they provide free, unbiased plan comparisons and won't try to sell you anything.

Montana families navigating Big Sky Rx alongside the Medicare Savings Programs and Extra Help can find the complete application sequence, income worksheets, and document checklists in our Montana Medicare Savings Programs guide.

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