Medicare Extra Help: What Is It & How Do You Qualify? | (Full Guide)

Though many people may qualify for Medicare Part A with no premium, there is still a premium associated with Medicare Part B and prescription drug coverage, or Medicare Part D. In addition to the monthly premium, there are also other costs related to drug plans like deductibles and copayments. Many Social Security recipients may not have the financial resources to cover these costs. So, how do you get these critical medications if you cannot afford the cost? The Medicare Extra Help program can help people with limited income and resources with out-of-pocket expenses associated with a prescription drug plan. Keep reading to learn how you can qualify for this program and how to get signed up.

 

What Is Medicare Extra Help?

Medicare Extra Help is a Federal assistance program that helps Medicare beneficiaries with the costs of prescription drug coverage. It is also called the Part D Low-Income Subsidy (LIS). The program can assist with Part D premiums, deductibles, coinsurance payments, and the out-of-pocket costs of some medications. In some cases, the program can completely eliminate your Part D deductible. The Social Security Administration (SSA) estimates that this program is worth approximately $5,100 per year to recipients.

In addition to the benefits mentioned above, the Extra Help program also eliminates late enrollment penalties when you enroll in a Medicare prescription drug plan. The program provides a lengthy special enrollment period each year for new enrollees to get signed up for a drug plan. If you qualify for Extra Help, then you can also avoid the late enrollment penalty. To receive Extra Help, you will obviously need to be eligible for Medicare, although you do not have to be enrolled in Part D to apply for Extra Help.

 

Income Limits For Extra Help Prescription Drug Plan

So, what are the income and resource limits to qualify for Extra Help? There are different income and resource limits depending on the level of Extra Help that you might receive. To be eligible for full Extra Help benefits, you should have a monthly income below $1,439 for an individual or $1,980 for a married couple. In addition, you can have no more than $9,900 in assets or $15,600 for a married couple. These limits will qualify you for the full Extra Help program. This means that you will pay no premium or deductibles on your Medicare prescription coverage. You also qualify for pharmacy assistance in the form of a $3.95 generic copay and a $9.85 brand-name copay.

If you do not meet the requirements above, you might still qualify for partial Extra Help. If your monthly income is below $1,630 ($2,198 for married couples) and your assets are below $15,510 ($30,950 for married couples), then you qualify for partial Extra Help. This means that you will not pay a premium for Part D coverage, and your deductible will only be $99. In addition to the income requirements, you also must reside in one of the 50 states (including Alaska and Hawaii) or the District of Columbia.

Recipients of Medicare and Medicaid might also be able to qualify for Extra Help, but the income limits are lower. If you are a beneficiary of both programs, then you can have no more than $1,093 in monthly income. In some cases, if you qualify for Medicaid or certain Medicare Savings programs, then you can automatically qualify for Extra Help. Many people receiving Supplemental Security Income (SSI) benefits will also qualify for this program.

How To Apply For Medicare Part D Extra Help Program

Applying for this program is not difficult. You can visit Medicare.gov to get started with an online application for the Extra Help program. The easiest and fastest way to apply is by completing the online application. You should remember, however, that applying for Extra Help does not enroll you in Medicare prescription drug coverage. You will need to enroll in a drug plan separately through the health care insurance provider of your choice. You may even choose to enroll in a Medicare Advantage plan that includes drug coverage.

If you cannot complete your application online, there are other ways that you can apply for this helpful program. You may call the Social Security Administration toll-free at 1-800-772-1213 (TTY Users 1-800-325-0778) to complete an application for the Extra Help program. You can call 1-800-Medicare to learn more about your options for prescription drug coverage. Lastly, you can make an appointment at your local Social Security office to complete a paper application in person. Remember that these offices do not accept walk-ins currently, so you will need to call and schedule an appointment first.

 

Documentation Required For Extra Help

When completing your Extra Help application, there is certain documentation that you will need to present that proves your eligibility for the program. You will need your Social Security card and number to prove your identity when applying for the program. Next, you will need documents that prove your income and assets. Some of these include tax returns, bank statements, payroll slips, Social Security benefit letters, and other items that show how much money you make each month.

You might also be required to present statements from a savings account or retirement accounts like a 401k or IRA. If you receive veteran’s benefits or benefits from the Railroad Retirement Board, then be prepared to show those as well. There is no specific list of documents that will be required, but you should be prepared to show any documents necessary to prove your income level and assets. If you do not truly need assistance with Medicare prescription drug costs, you will likely not be approved for the program.

 

Medicare Savings Programs (MSPs)

Medicare Savings Programs are state-sponsored programs that assist with Medicare expenses. These programs can help you with expenses related to Medicare Part A and Part B as well. They provide assistance for premiums, deductibles, copays, and other out-of-pocket expenses. There are four different types of MSPs. These are as follows:

 

  • Qualified Medicare Beneficiary Program
  • Specified Low-Income Medicare Beneficiary Program
  • Qualifying Individual Program
  • Qualified Disabled And Working Individuals Program

 

As with Extra Help, you must show a financial need to enroll in these MSPs. Stocks, bonds, and money in savings or checking accounts will count toward your resource limit. Your home, one car, and up to $1,500 in burial expenses will not count toward your limit. If you want to apply for an MSP, then you will need to contact your state Medicaid office. They can assist you with the options available and help with your application.

The Bottom Line

Medicare Extra Help is an extremely beneficial program that helps people with financial needs cover expenses associated with their prescription drug coverage. In some cases, you may qualify for premium-free drug coverage as well as a zero deductible. Completing an application online is the quickest way to get approved, but remember that you will need to enroll in a prescription drug plan separately from the Extra Help program. If you think you qualify, then go ahead and start your application today.

 

Frequently Asked Questions

 

What does Medicare Extra Help pay for?

Medicare Extra Help pays for costs associated with Medicare prescription drug coverage. This can include premiums, deductibles, and copayments. It can also help reduce the cost of certain prescription drugs. The SSA estimates that this plan provides approximately $5,100 of annual benefits to recipients. This is an enormous help to those who cannot afford to pay the costs associated with their Medicare drug plans.

 

What is the difference between Medicare and Medicare Extra Help?

Here are the basics of Medicare. Medicare is medical insurance that is used when you visit the doctor or hospital. It pays for medical services and items like doctor visits, hospital stays, or medical equipment. You might also have premiums, deductibles, and copays associated with this coverage. Medicare Parts A and B combine to provide this traditional hospital and doctor office health insurance. So, what is Medicare Part D? Part D prescription drug coverage is the portion of Medicare that helps cover the costs of medication. It is basically prescription insurance. The Extra Help program specifically helps cover the cost of prescription drug coverage for people with a financial need. You must have limited income and resources to qualify for this program.

 

Can you get Extra Help if you have a private insurance plan?

Yes, you can still receive Extra Help even if you are enrolled in a Medicare Advantage Plan through a private insurance company. You will need to work closely with your insurance provider to make sure that you are paying the proper costs depending on the level of Extra Help that you are receiving.

Elliot Marks

Elliot Marks

Elliot has spent years providing clear and concise information to help navigate the complex nuances of social security and many other government services in the United States. Elliot has a passion for helping those in need of these services to be able to find timely access to news and information that is relevant and helpful to their daily lives.