Prescription drugs are expensive, and many people struggle to find ways to pay for their medications. Since these medications are medically necessary, some people find themselves doing without other basic necessities to pay for them. If you are enrolled in Medicare, you might qualify for the Extra Help program to get financial assistance related to your prescription drug coverage.
The Medicare Extra Help program can help pay your monthly premiums, deductibles, and copays related to your Medicare drug plan. This program is limited to those with a financial need for this type of assistance program. If you need help paying for your prescription drug coverage through Medicare, then keep reading. We will tell you what the Extra Help program is, what it covers, how to qualify, and how you can apply for these benefits.
What Is Medicare Extra Help & What Does It Cover?
Medicare Extra Help is a Medicare program that helps eligible individuals pay for costs associated with their Medicare Part D prescription drug plan. Help may include financial assistance with monthly premiums, deductibles, and copays. In addition, the cost of medications for Extra Help beneficiaries is reduced as long as the medication is on the plan’s formulary and the beneficiary uses a network pharmacy. You might also hear about the Extra Help program called the Part D Low-Income Subsidy program.
Extra Help is a federal program administered by the Social Security Administration. This Medicare prescription drug coverage assistance is estimated to be worth about $5,100 per year to its beneficiaries. This program is a lifesaver for some participants as they would not otherwise be able to afford their prescription drug costs. As previously mentioned, Extra Help covers Part D premiums, deductibles, and copays for Medicare beneficiaries enrolled in the program. Extra Help also reduces your coinsurance amounts for medications and prevents you from paying any late enrollment penalties associated with Part D coverage. Beneficiaries who qualify for Extra Help are entitled to a nine-month special enrollment period each year from January through September. You may be entitled to full Extra Help benefits or only partial Extra Help benefits based on your situation. We will discuss the eligibility criteria in more detail in the next section.
Extra Help Income Limits & Eligibility Requirements
So, who qualifies for Extra Help? Some people are automatically enrolled in the Extra Help program, while others will need to apply manually. For those who will be enrolled automatically, no additional requirements must be met. Automatic enrollees include those on full Medicaid coverage, those enrolled in a Medicare Savings Program (assistance with Medicare Part B premiums from a state program), and Social Security SSI (Supplemental Security Income) recipients. If you meet any of those criteria, then the income limits specifically associated with the Extra Help program do not apply.
If you need to enroll manually, the Extra Help program is also available for low-income individuals who are not enrolled in one of the other programs mentioned above. In 2022, individuals will usually need an annual income of less than $20,385 and resources of less than $15,510. For a married couple, the limits increase to $27,465 and $30,950, respectively.
Remember that not everything you own counts toward your resource limit. Typically, stocks, bonds, and money in a savings or checking account will count toward the limit. However, your home, one car, a burial plot, furniture, household items, some life insurance policies, and up to $1,500 in burial expenses will not count toward the limit.
How To Apply For The Extra Help Program
If you have a limited income and think you might qualify for Extra Help, you need to know how to apply for these benefits. First, remember that many plan participants are automatically enrolled in the program. If you are automatically enrolled, you should receive a letter in the mail with details of your new drug plan. The letter should outline the details of how much you will pay for your coverage.
For those who need to apply for the program, you should complete the Extra Help application online. Be aware that you must live in one of the 50 United States or the District of Columbia. You might also be required to provide documentation of your financial need, including bank statements, tax returns, or other documentation. If you cannot complete your application online, you can also call 1-800-Medicare or the Social Security Administration (SSA) toll-free at 1-800-772-1213 to start the application process. TTY users can call 1-800-325-0778. You can visit Medicare.gov to learn more about the application process. You can also visit your local Social Security office to start your application.
If you are approved, you will get a letter in the mail detailing your benefits. For those not already enrolled in a qualified Part D plan, you will be automatically enrolled in a Part D drug plan. The level of Extra Help that you receive will depend on your income.
Choosing The Right Prescription Drug Plan With Medicare Extra Help
Some people already have prescription drug coverage before enrolling in Extra Help. If you are already enrolled in a plan through your employer, or you receive retiree coverage through a union or previous employer, you should check with your plan prior to enrolling in Extra Help. Enrollment in Extra Help might cause you to lose your existing coverage, and your current medical insurance coverage might be a better fit for your needs. If you are enrolled in Medicaid, make sure you fully understand how Extra Help will affect your coverage by contacting your state Medicaid office. You should weigh the details and cost of your current plan against the benefits provided by Extra Help.
If you do not have prescription drug coverage, you will be automatically enrolled in a qualifying Medicare prescription drug plan. You will receive a letter in the mail that outlines your coverage details and costs. Just because you are enrolled in a plan automatically does not mean that you can never change your coverage. Social Security Extra Help beneficiaries receive a nine-month special enrollment period each year, during which they can change their Part D plan without any penalty. You might decide to enroll in a Medicare Advantage plan that includes Medicare Part A, Part B, and Part D. However, you should verify that the plan will be eligible for Extra Help before enrolling.
Whatever plan you choose should fit your current needs. When making your decision, you should closely examine the total estimated out-of-pocket cost of each plan. Remember, those monthly premiums are not the only Medicare costs associated with a plan. You should also consider deductibles, copays, and coinsurance amounts when deciding on the right plan to fit your needs.
Medicare Savings Programs
If you already participate in a Medicare Savings program, you will be automatically enrolled in Medicare Extra Help. There are four different types of Medicare Savings programs, and each of them is meant to help low-income individuals with their Medicare expenses. The four types are the Qualified Medicare Beneficiary (QMB) program; Specified Low-Income Medicare Beneficiary (SLMB) program; Qualifying Individual (QI) program; and Qualified Disabled Working Individual (QDWI) program. The eligibility requirements for each program are a little different, but the goal of each program is roughly the same.
Medicare Savings programs are administered by each individual state. You apply through your state program, and your state determines the income requirements and eligibility criteria for each. You should know that the income limits are slightly higher in Alaska and Hawaii for most programs. These programs help pay for your Medicare Part A and Part B premiums. In addition, they might also pay for deductibles, copays, and coinsurance amounts.
The Bottom Line
Medicare Extra Help provides prescription drug plan cost assistance to enrollees. To qualify for the program, you must meet the income requirements or already participate in another low-income program, like a Medicare Savings Program. Extra Help covers your Part D premium, and it can also pay for copays and deductibles. In addition, it lowers the cost of generic and brand-name drugs at network pharmacies. You can qualify for full Extra Help or partial Extra Help, depending on your income level.
Frequently Asked Questions
How much can you make on Social Security and still get Extra Help?
An individual can generally make no more than $20,385 and still get Extra Help. For a married couple, that number rises to $27,465. In addition to the income limits, you must also have limited resources to qualify for Extra Help. Stocks, bonds, cash in the bank, and some other accounts count toward your resources. An individual must have less than $15,510 in resources, and a married couple must have less than $30,950 in resources.
Is Medicare Extra Help free?
Yes, Medicare Extra Help is free for those who qualify. Not only is the program free, but it saves you money. It helps pay for at least a portion of your Medicare Part D monthly premium, and it also covers some copays and deductibles. Finally, it lowers your out-of-pocket costs for prescription drugs at network pharmacies. Since Extra Help is designed to help low-income individuals, there is no cost associated with the program.
Does Extra Help cover Part B premiums?
No, Extra Help does not cover your Part B premiums. Extra Help only provides assistance with costs related to your Part D drug plan. If you need help with your Part B premium, you should attempt to qualify for a Medicare Savings Program. These programs help with Part A and Part B premiums as well as copays, deductibles, and coinsurance amounts. These savings programs are administered at the state level, so you should contact your state office to see if you qualify.
What is the difference between Extra Help and Medicare Advantage?
Medicare Advantage plans, or Medicare Part C, combine traditional Medicare coverage into a single plan. Private insurance companies administer Advantage plans, and these plans can include Part A, Part B, and Part D coverage. On the other hand, Extra Help is a financial assistance program designed to help low-income individuals with costs related to their Part D plans. Extra Help is not a type of coverage; instead, it is a federal assistance program that helps cover the cost of part of your Medicare coverage.