What is Extra help?
Anyone who has Medicare can get Medicare prescription drug coverage. Eligible beneficiaries who have limited income and/or assets may qualify for a government program that helps pay for Medicare Part D Prescription drug costs. This is called ExtraHelp. Medicare beneficiaries receiving ExtraHelp get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments. Also, individuals enrolled in the ExtraHelp program do not have a gap in prescription drug coverage, also known as the coverage gap, or the Medicare "donut hole." The amount of subsidy depends on the individual's income compared to the Federal Poverty Level and resource limitations set by the Social Security Act.
Extra Help is estimated to be worth about $4,000 per year on average per person enrolled in Extra Help, according to Social Security. Many people qualify for these important savings and don’t even know it. Our producers have helped hundreds of individual apply for Extra Help saving them thousands of dollars.
Extra Help for Part D Costs
Our federal government offers help with paying for your Part D drug plan expenses if you qualify based on income. This is called the Low-Income Subsidy. Anyone can apply for this at Social Security at any time, but help is awarded based on proving low-income and limited resources. You must have an annual income that falls below 150% of the Federal Poverty Level based on your household size.
Beneficiaries who qualify will receive assistance with paying their monthly Part D premiums, their annual Part D deductible, and also their co-payments for retail medications. There are different levels of qualification, and the subsidy level generally determines how much assistance you will get with premiums. Someone qualifying a full subsidy would have 100% of their Part D premium paid for, up to the benchmark allowed by Medicare for that year.
For example, if you get an award notice that says you have a full subsidy, and the benchmark for the year is $34, then you can choose any drug plan you like, and the LIS program will pay up to $34/month toward your premiums. Choosing a drug plan with a premium of $34 or less in that scenario would mean you pay nothing for your drug plan. Furthermore, you will pay no deductible if your plan has one, and your copays for medications are greatly reduced. If you think you may qualify, it is worth contacting Social Security for an application.
How do I apply?
Applying for Extra Help is easy. Just complete Social Security’s Application for Extra Help with Medicare Prescription Drug Plan Costs (Form SSA-1020). Here’s how:
- Apply online at www.socialsecurity.gov/extrahelp;
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) to apply over the phone or to request an application; or
- Apply at your local Social Security office.
After you apply, Social Security will review your application and send a letter to you to let you know if you qualify for Extra Help. After you qualify, you can choose a Medicare prescription drug plan. If you do not select a plan, the Centers for Medicare & Medicaid Services will do it for you. The sooner you join a plan, the sooner you begin receiving benefits. If you aren’t eligible for Extra Help, you still may be able to enroll in a Medicare prescription drug plan.
Extra Help Comparison Chart
| If you have Medicare and Medicaid and/or a Medicare Savings Program | |||
|---|---|---|---|
| You are enrolled in... | And your income is... | Then you get... | Your 2017 copays are... |
| Medicaid | Up to $1010 ($1,355 for couples) per month in 2017 | Full Extra Help $0 premium and deductible |
$1.20 generic copay $3.70 brand-name copay No copay after $4,950 in out of pocket drug costs |
| Medicaid and/or the Medicare Savings Program | Above $1010 ($1,355 for couples) per month in 2017 | Full Extra Help $0 premium and deductible |
$3.30 generic copay $8.25 brand-name copay No copay after $4,950 in out of pocket drug costs |
| If you have Medicare Only | |||
| And your income is... | And your assets are... | Then you can get... | Your 2017 copays are... |
| Up to $1,356 ($1,822 for couples) per month in 2017 | Up to $8,890 ($14,090 for couples) in 2017 | Full Extra Help $0 premium and deductible |
$3.30 generic copay $8.25 brand-name copay No copay after $4,950 in out of pocket drug costs |
| Below $1,505 ($2,022 for couples) per month in 2017 And your income and/or assets are above Full Extra Help Limits |
Up to $13,820 ($27,600 for couples) in 2017 And your income and/or assets are above Full Extra Help Limits |
Partial Extra Help Premium depends on your income$82 deductible or the plan's standard deductible, whichever is cheaper. |
15% coinsurance or the plan copay, whichever is less After $4,950 in out of pocket drug costs, you pay $3.30/generic and $8.25/brand-name or 5% of the drug cost, whichever is greater. |
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Our mission is to make a positive difference in the lives of Medicare eligible tribal members. We help tribal members save money and receive more benefits that are available to them. We can help you, as a Medicare eligible tribal member, and the benefits that best fit your needs. We may also be able to help determine if you qualify for additional benefits and income.