Extra Help is a type of financial aid for persons who have a prescription drug plan but need assistance paying for it. This programme is a terrific method to get help paying for prescription drug prices if your income and assets do not exceed the threshold.
Within a Medicare prescription drug plan, Extra Help helps with monthly premiums, annual deductibles, and copayments. You’ll need to provide some information about your income and resources in order to apply for Extra Help.
Table of Contents
- 1 What is Extra Help?
- 2 Medicare Extra Help pros
- 3 Medicare Extra Help cons
- 4 Applying for Extra Help
- 5 Customer satisfaction
- 6 Extra assistance from Medicare for low-income individuals
- 7 Who is eligible to participate?
- 8 What are the advantages?
- 9 What is the Medicare Extra Help income limit?
- 10 What criteria are used to set income limits?
- 11 What is not counted toward the income limit?
- 12 When you are no longer eligible
- 13 Other considerations and options
- 14 What to do if you don’t qualify for Extra Help with Medicare prescription drug costs any longer?
- 15 Will I be automatically qualified next year if I qualify this year?
- 16 What should I do if I am not automatically qualified?
- 17 What is the process for applying for Extra Help?
- 18 What if I’m still not eligible for Extra Assistance?
- 19 The bottom line
What is Extra Help?
Extra Help is a programme that assists persons with limited income and resources with costs associated with the Medicare prescription medication programme, such as premiums, deductibles, and coinsurance. You won’t have to incur a late enrollment penalty if you qualify for Extra Help while enrolling in a Medicare medication plan.
Prepare your application by gathering your Social Security card, bank account statements (including checking, savings, and CDs), Individual Retirement Accounts (IRAs), stocks, bonds, savings bonds, mutual funds, and other investment statements, tax returns, payroll slips, and your most recent Social Security benefits award letters. Statements from any Railroad Retirement benefits, Veterans benefits, pensions, or annuities may also be required.
Even if you don’t have all of these documents, you can make an educated guess, and the Social Security Administration will determine whether or not you are likely to qualify. You may be required to supply documents in the future, however.
You can start the process of getting help from your state with other Medicare costs through the Medicare Savings Programs by applying for Extra Help. Your information is sent from the Social Security Administration to your state, which then contacts you about other savings programs if you qualify. You can still apply for Extra Help even if you don’t want your information sent to your state.
Just because you qualify for Extra Help doesn’t ensure you’ll always be eligible; if your income or assets grow, you may need to update your information and pay your Prescription Drug Plan charges.
Medicare Extra Help pros
- Helps pay Medicare prescription drug coverage costs
Original Medicare does not cover prescription pharmaceuticals, but a Prescription Drug Plan can be too expensive for low-income individuals, leaving many without access to medications. Extra Help comes to the rescue by assisting low-income Medicare enrollees in paying for their Prescription Drug Plan.
- Savings can be significant
According to the Social Security Administration’s forecasts for 2021, Extra Help might save you around $5,000 per year.
- Some people automatically qualify
If you’re eligible for both Medicaid and Medicare, Medicaid will assist you to pay your Medicare Part B premiums through a Medicare Savings Program (MSP), or you’ll be immediately qualified for Extra Help if you have both Medicare and Supplemental Security Income (SSI). Even if you aren’t automatically eligible, you can apply to determine whether you are.
- Enrollment assistance
A Special Enrollment Period (SEP) is in effect, giving you more time to enroll in a PDP.
- Penalties are no longer in effect
If someone delays enrolling in a PDP, late enrollment penalties may apply. These sanctions will not be enforced.
Keep in mind that Medicare Extra Help is not a substitute for Medicare Part D and cannot stand alone. Original Medicare is still required.
Medicare Extra Help cons
- Must meet income and asset limits
If you’re qualified for both Medicaid and Medicare, Medicaid will help you pay your Medicare Part B premiums through a Medicare Savings Program (MSP), or if you have both Medicare and SSI, you’ll be immediately eligible for Extra Help. You can apply to check if you’re qualified even if you don’t qualify automatically.
- Can’t combine with Medicare Advantage plans
You must have a Stand-alone Prescription Drug Plan in order to get Extra Help subsidies; however, you cannot have a Medicare Advantage Plan. You can’t have both. If you want a comprehensive managed care plan that bundles all of your Medicare coverage—which you’d receive with Medicare Advantage—you’ll have to pick between the two.
Applying for Extra Help
You can apply for Extra help online, by phone, or by mail.
Fill out the Extra Help Application online at the Social Security website. If you start but don’t finish the application, you can save your work, acquire a re-entry number, and come back to finish it.
To apply over the phone, call 800-772-1213 between the hours of 8 a.m. and 7 p.m., Monday through Friday. You can also request a paper application by calling this number.
Your local Social Security Office is likely closed for in-person assistance due to the epidemic, but they may be able to help you apply over the phone until they reopen. The Social Security Office Locator can help you find your nearest office.
- General help
For information about Medicare Savings Programs or Medicare Prescription Drug Plans, call 1-800-MEDICARE or go to www.medicare.gov.
You can also seek assistance from your state’s State Health Insurance Counseling and Assistance Program (SHIP). Visit www.shiphelp.org to find your local SHIP, or call 877-839-2675 or email email@example.com.
Extra Help isn’t assessed or rated directly, although Medicare beneficiaries generally express satisfaction with their prescription drug coverage. According to a study of Medicare beneficiaries conducted in 2021, 87 percent stated their prescription medication coverage was satisfactory, and 85 percent said their Medicare Part D Prescription Drug Plan provided acceptable value. The majority of respondents stated they could afford their Prescription Drug Plan premiums; 84 percent said their monthly premiums are affordable, and 76 percent said their out-of-pocket payments are reasonable.
While the fees of Medicare Prescription Drug Plans vary depending on the carrier, area, and level of coverage, joining the Extra Help program is free. The simplest method to find out how much a Prescription Drug Plan costs in your area is to go to Medicare.gov and compare choices.
- Competition: Extra Help vs. Humana
Extra Help is a financial help program for Medicare beneficiaries who are having difficulty paying for their Prescription Drug Plan charges. Prescription drug coverage is available through most Medicare Advantage plans, and many insurers provide Stand-Alone Prescription Drug Plans.
To be eligible for Extra Help, you must enroll in a Prescription Drug Plan. Humana, for example, has Medicare plans available in 85 percent of U.S. counties, the most of any Medicare insurer. 8 The Humana Basic Rx Plan, which is excellent for people who qualify for Extra Help, is one of three types of stand-alone prescription drug plans offered by Humana. This plan’s monthly premiums range from $19.70 to $45.00, and many medications in all levels have no or extremely low copayments.
Extra assistance from Medicare for low-income individuals
Individuals with low income who have Part D prescription medication coverage may be eligible for assistance with deductibles and copays. The Low-Income Subsidy is another name for this extra assistance (or LIS).
Who is eligible to participate?
Persons must be qualified for Medicare Part D and have an income of less than 100% of the Federal Poverty Level for a full benefit or less than 150 percent of the Poverty Level for a partial benefit to qualify for Extra Help.
What are the advantages?
The amount of money received depends on the recipient’s income and living situation. Extra Help will usually cover a person’s monthly medication plan payment if the plan is Extra Help approved. It will also cover the cost of the annual membership.
It will also cover the annual deductible ($480 in 2022), though partial subsidy beneficiaries will be responsible for the remaining $99 deductible. Extra Help will also cover all pharmaceuticals in the coverage gap, or doughnut hole, for partial subsidy clients, or 85 percent of drug expenses. Individuals will pay $3.95 for generic or multi-source medications and $9.85 for other medications.
The coverage gap begins in the standard benefit when Medicare beneficiaries spend $4,430 in prescription costs in 2022; however, Extra Help recipients will continue to pay co-payments of $3.95 for generic or multi-source drugs with a retail price under $79 and 5% for those with a retail price greater than $79. Beneficiaries would pay $9.85 for brand-name medications under $197 and 5% for those with a retail price over $197.
Getting extra assistance with your Part D can be beneficial.
- Reduce your prescription drug out-of-pocket payments.
- Your monthly Part D premiums will be eliminated.
- Your annual Part D deductibles can be reduced or eliminated.
The coverage gap, often known as the donut hole, should be eliminated. This means that your prescriptions will not be more expensive only because you exceeded a spending restriction in a given year.
Extra Help is expected to save beneficiaries $5000 per year in prescription drug costs on average.
What is the Medicare Extra Help income limit?
Extra Help is a financial assistance program for Medicare recipients. It assists those with low financial resources in managing the expense of prescribed medications. Eligibility is determined by a set of income guidelines.
A low-income subsidy is sometimes known as Extra Help (LIS). This means that the amount of government assistance a person receives will vary depending on their income and financial need.
By assisting with premiums, deductibles, and copayments, Medicare Extra Help might save an individual a significant amount of money each year.
Despite the fact that the Extra Help program is valuable, many people who qualify have yet to enroll.
What criteria are used to set income limits?
The federal poverty level (FPL) is used by the government to set income limits. The level is set for each state every year, depending on the cost of living and average income.
The income limit for Medicare Extra Help changes in line with the federal poverty level.
If a person has a higher income, they may still qualify depending on the circumstance. Examples include those who live in Alaska or Hawaii or those who support a dependent family member.
People may qualify for either full or partial Extra Help, depending on their income and assets.
What is not counted toward the income limit?
Medicare does not count certain kinds of payments or assistance towards the income limit for Medicare Extra Help. These include:
- food stamps or the Supplemental Nutrition Assistance Program (SNAP)
- aid with housing
- energy aid for the home
- payments of earned income tax credits
- assistance during a disaster
- victim compensation payments
- grants for education and scholarships
Medicare also disregards any funds contributed by others to help with a person’s household expenses.
When you are no longer eligible
Extra Help may remain the same, increase, diminish, or terminate depending on a person’s circumstances. Even if a person is no longer eligible for Medicare Extra Help, their coverage will be extended until the end of the year.
Extra Help eligibility is reviewed by the Social Security Administration on a regular basis. A request for additional information may arrive, and the request must be completed and returned within 30 days.
If a person fails to return the form or returns it late, their Extra Help benefits will expire in January of the following year.
Even if a person no longer qualifies for Extra Help, they may still be eligible for assistance with prescription drug costs.
People should make touch with their Medicaid office or State Health Insurance Assistance Program (SHIP) for information on the support available.
Other considerations and options
The government offers four different Medicare savings programs to help with Part A and Part B premium payments.
Because the requirements for these programs differ by state, persons should call the Social Security Administration at 800-772-1213 to see if they are eligible.
The following programs can assist someone in paying for their Medicare expenses:
- Part A and Part B premiums, deductibles, coinsurance, and copayments are all covered by qualified Medicare Beneficiaries (QMB) programs.
- SLMB (Specified Low-Income Medicare Beneficiary) programs assist those with Part A and a limited income in paying their Part B premiums.
- Qualifying Individual (QI) programs assist those with Part A and a low income in paying their Part B premiums.
- Qualifying Individual (QI) programs assist persons with Part A and a low income in paying their Part B premiums. A person must apply each year and is ineligible to apply if they are eligible for Medicaid.
- Working disabled people aged 65 and under who lost their premium-free Part A when they returned to work are eligible for Qualified Disabled and Working Individuals (QDWI) programs, which help with the Part A premium.
- For low-income persons, the Medicare Extra Help program provides assistance with prescription drug expenditures.
To be eligible, you must have a combined income of less than $19,140 and assets of less than $14,610. With resources of $29,160 or less, a married couple’s income increases to a combined $25,860.
People can enroll in a Part D plan immediately after Medicare approves their application, without having to wait for an enrollment period or paying a late enrollment penalty.
What to do if you don’t qualify for Extra Help with Medicare prescription drug costs any longer?
Extra Help implies that Medicare will cover your monthly premium, deductible, and copayments for your Medicare Prescription Drug Plan.
If you have one of the following, you are automatically eligible for Extra Help:
- Both Medicare and Medicaid are available.
- Medicaid will pay your Medicare Part B (Medical Insurance) premiums (if you are enrolled in a Medicare Savings Program)
- Medicare and Supplemental Security Income (SSI) Extra Help is only available if you enroll in a Medicare medication plan.
Will I be automatically qualified next year if I qualify this year?
If your income and resources have changed since last year and you no longer qualify for one of the programs listed above, you may no longer be eligible for Extra Help. If you are no longer automatically eligible for Extra Help, you will receive a notice (on gray paper) in the mail by the end of September, along with an application and postage-paid envelope. The good news is that you may still be eligible for Extra Help if you receive this notice. To discover it, you must apply.
Extra Help can be applied for through Social Security or the Medicaid office in your state. You’ll have to start paying a monthly premium if you don’t qualify.
You may be disenrolled if you do not make these payments. You may be dropped from your drug plan if you don’t make these payments. If you still qualify for Extra Help, but your eligibility level changes in 2022, you’ll have received an orange-colored notification in the mail in early October with your new copayment amounts. You may be dropped from your drug plan if you don’t make these payments.
If you still qualify for Extra Help, but your eligibility level changes in 2022, you’ll receive an orange-colored notification in the mail in early October with your new copayment amounts. If you don’t receive a notice from Medicare, you’ll continue to receive the same level of Extra Help in 2022 as you did in 2021, however, your actual copayment amount may fluctuate owing to yearly Extra Help program revisions. Your medication plan will still send you a notification informing you of your copayments for 2022.
What should I do if I am not automatically qualified?
You should apply for Extra Help if you make $19,140 or less per year as an individual, or $25,860 or less per year as a married couple living together. Even if your yearly income is higher, you or your spouse may still be eligible if your resources are $14,610 or less for a person or $29,160 for a married couple living together.
Your money and stocks are resources, but they do not include your home, car, or the amount of any life insurance you may have.. The figures above are for 2020, however they may change in 2022. You should still apply if your income and resources are slightly higher.
What is the process for applying for Extra Help?
Applying for Extra Help is completely free. If you qualify, apply as soon as possible to ensure that you receive Extra Help beginning January 1, 2022. There are three options for submitting an application:
- Go to socialsecurity.gov/i1020 for more information.
- Call 1-800-772-1213 to apply over the phone, request a paper application, or schedule
an appointment at your local Social Security office. Call 1-800-325-0778 if you are using a TTY.
- For the phone number of your local Medicaid office, go to Medicare.gov/contacts or call
1-800-MEDICARE (1-800-633-4227). For TTY users, dial 1-877-486-2048.
What if I’m still not eligible for Extra Assistance?
If you don’t qualify for Extra Help, consider the following alternatives for saving money on prescription medication coverage.
- Your state may offer programmes to assist you in paying for prescription drugs.
For further information, contact your local Medicaid office or the State Health Insurance Assistance Program (SHIP).
For your Medicaid office’s phone number, go to Medicare.gov/contacts, and for your SHIP’s phone number, go to shiptacenter.org.
- Starting January 1, 2022, you may choose to switch to a new Medicare drug plan. See what your current plan’s costs will be in 2022 if you don’t add Extra Help.
- Compare your current plan to comparable plans in your region. Compare your current plan to different plans in your area to see if you may save money.
Visit https://www.medicare.gov/plan-comparison/ to compare plans. You can also get assistance by calling 1-800-MEDICARE (1-800-633-4227). Call 1-800-486-2048 if you are using a TTY.
- You can also get support from your SHIP. For your SHIP’s phone number, go to
shiptacenter.org. When comparing plans, make sure the one you choose covers the drugs you use. Check to check whether you may continue to fill medicines at the same pharmacy if that is important to you.
If you are no longer eligible for Extra Help for the next year, you can transfer plans again from January 1 to March 31, 2022. Remember that if your income or resources change, you can reapply for Extra Help at any time. For more information,
- Visit socialsecurity.gov/prescriptionhelp for more information about Extra Help.
- You can also call the Social Security Administration at 1-800-772-1213. 1-800-325-0778 (TTY).
- For additional information about Medicare prescription drug coverage, go to: http://www.medicare.gov/prescription-d
- Go over your “Medicare & You” guide with care.
- Go to Medicare.gov for further information.
- Dial 1-800-MEDICARE from anywhere in the United States.
- For free individualized health insurance counseling, contact your SHIP..
- For your SHIP’s phone number, go to shiptacenter.org.
You have the right to receive Medicare information in a format that is easy to understand, such as big print, Braille, or audio.
If you believe you have been discriminated against, you have the right to file a complaint. For more information, go to Medicare.gov/about-us/accessibility-nondiscriminationnotice or call 1-800-MEDICARE (1-800-633-4227). For TTY users, dial 1-877-486-2048.
If you qualify for Medicare Extra Help, your state may be able to assist you in paying for your prescription drug costs. Extra Help is a programme that aids people with low income and resources with costs associated with the Medicare prescription medicine programme, such as premiums, deductibles, and coinsurance, if their income and assets do not exceed the threshold limit. If you qualify for Extra Help when enrolling in a Medicare drug plan, you won’t have to pay a late enrollment penalty. So what are you waiting for? Go check your eligibility and apply if you are eligible and help yourself survive these trying times.