Medicare - Extra Help

Medicare Part D - Extra Help Program

What is Extra Help?

Part D prescription drug coverage is available for any Medicare beneficiary. Extra Help is a program within Medicare that assists individuals with the cost of their Part D prescription drug plan. Some Medicare beneficiaries with limited resources and income are eligible for the Extra Help program.


What does Extra Help cover?

Extra Help assists eligible beneficiaries with paying for costs associated with their Medicare Part D prescription drug plan, like annual deductibles, monthly premiums and prescription co-payments or coinsurance.


How Much Will You Pay In Extra Help?

With the full Extra Help benefit in 2018, an eligible beneficiary should pay no more than $3.35 for a generic drug (or a brand-name drug treated as a generic) and $8.35 for any other brand-name drug. For those qualifying for partial Extra Help, an eligible beneficiary should pay no more than 15 percent of the cost of drugs on your plan’s formulary (or list of covered drugs)–or the plan copay, whichever is less—until you reach the out-of-pocket maximum. Most people who qualify for Extra Help also pay nothing, or a reduced amount, for their monthly premium and annual deductible.

Medicare enrollees who have Medicaid, live in an institution like a nursing home, or receive home and community-based services should not be paying anything out of pocket for their prescription drugs.


How to Qualify for Extra Help

Many Medicare beneficiaries qualify for Extra Help and don’t even know it. To qualify for Extra Help:

1)  You must been rolled in a Medicare Part D prescription drug plan.

2)  You must reside in one of the 50 states

3)  Your annual income must be less than $18,090 for an individual or $24,360 for a married couple living together. Even those individuals or couples with incomes exceeding the threshold may still be eligible for assistance .

4)  Your resources cannot exceed $8,890 for an individual or $14,090 for a married couple who live together to receive full Extra Help, or $13,820 for an individual or $27,600 for a married couple who live together to receive partial Extra Help. Resources include:  bank accounts, stocks and bonds. Resources do not include: your home, your car, or life insurance policies.


How to Apply for Extra Help

To apply for Extra Help, you must complete Social Security’s Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020). You can apply in the following ways:

•  Apply online at www.socialsecurity.gov/extrahelp

•  Call Social Security at 1-800-772-1213 to apply over the phone or to request an application;  or
•  Apply at your local Social Security office.


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