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FAQ: What Is the Medicare Extra Help Program?

The Medicare   Extra Help program helps cover Part D out-of-pocket costs for eligible beneficiaries.

Have you ever found yourself skipping a day of medication or cutting your pills in half to make your supply last a bit longer? If this sounds like you, then you’ll be happy to know that there’s help. Medicare has a special program known as Extra Help. If you qualify, you can sign up to get help paying for items such as: monthly premiums, annual deductibles, and prescription copayments in your Medicare drug plan.

Once you’re enrolled in this program, your prescription drug costs are no more than $2.65 for each generic drug and $6.60 for each brand-name drug. In 2013, you may qualify for Medicare Extra Help if:

    • You reside in one of the 50 United States
    • You have up to $17,235 in yearly income ($23,265 for a married couple)
    • You have up to $13,300 in resources ($26,580 for a married couple). Resources include such things as bank accounts, stocks, and bonds. Not included included as resources are your home, car, and any life insurance policy.

How Do I Apply for

Medicare Extra Help?

If you’re looking to apply for the Extra Help program, you must complete the Social Security Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020).  There are three ways to apply:

Also, you may be automatically qualified to receive Extra Help if you have Medicare and meet one of the following conditions:

    • Enrolled in Medicaid coverage
    • Receive help from a Medicare Savings Program (MSP)
    • Receive Supplemental Security Income (SSI) benefits

In the above mentioned instances, eligible individuals don’t need to apply for the Extra Help program because the subsidy will be granted automatically.

Once your eligibility has been established, you will get a Special Enrollment period to enroll in a Medicare Part D prescription drug plan from a private insurance company. During this period it’s your responsibility to choose a prescription drug plan. If you don’t do so, you’ll automatically be enrolled in a plan by the Centers for Medicare and Medicaid Services (CMS) during the month you attain eligibility.

Are you enrolled in the Medicare Extra Help program? Share your experience in the comments below.

Medicare hasn’t approved or endorsed this information.

Category: Insurance

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