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Medicare Extra Help helps low-income Medicare beneficiaries pay for prescription drug coverage. It can save eligible beneficiaries about $4,900 a year.
Medicare Extra Help is a federal assistance program that helps low-income Medicare beneficiaries pay for medication. It covers all or most of the monthly premiums and annual deductible of a Medicare Prescription Drug plan (Medicare Part D). It also covers most of your Medicare Part D copays or coinsurance.
While the amount of assistance varies by income, Medicare Extra Help saves eligible beneficiaries about $4,900 a year, according to the Social Security Administration.
Medicare, the federal health insurance program primarily for Americans 65 and over, comes in four parts. Medicare Savings Programs, or MSPs, help low-income beneficiaries cover out-of-pocket costs associated with Medicare Part A (hospital insurance) and Medicare Part B (doctors insurance). Medicare Extra Help helps low-income beneficiaries cover out-of-pocket costs associated with Medicare Part D, which covers prescription drugs. These expenses include:
If you are approved for an MSP, you automatically qualify for Medicare Extra Help, so it is possible to get financial assistance for all major Medicare expenses.
Learn more about the cost of Medicare.
MSPs and Medicare Extra Help do not cover costs associated with Medicare Part C (Medicare Advantage), which is a private alternative to Original Medicare (Parts A and B) and sometimes comes with prescription drug coverage.
You are eligible for Medicare Extra Help if you:
Note: You will need to have Medicare Part D, once you are approved for the Extra Help program.
Income and asset limits are based on the Federal Poverty Level (FPL), so they change every year in February or March. Below are the Medicare Extra Help income and asset limits for 2018:
|Single||up to $18,120 a year||up to $14,100|
|Married||up to $24,690 a year||up to $28,150|
Your assets include money in a checking, savings or investment accounts. They exclude your home, a car, burial plot, furniture and other personal items. You can also subtract $1,500 for burial expenses.
Your income level affects whether you qualify for Full or Partial Medicare Extra Help.
Beneficiaries receiving Medicaid or a Medicare Savings Plan receive Full Extra Help and pay:
Medicare-only beneficiaries making up to $16,632 a year with up to $9,060 in assets ($22,464 in income and $14,340 in assets, if they’re married) also receive Full Extra Help and pay:
Medicare-only beneficiaries making more than the figure directly above, but still within the income and asset limits receive Partial Extra Help and pay:
State benchmark Medicare Extra Help premiums in 2018 run between $22 to $40.
You automatically qualify and therefore do not need to apply for Medicare Extra Help if:
In all other scenarios, you can apply online for Medicare Extra Help on SSA.gov. You can also apply in person at your local Social Security office or call 1-800-722-1213 to apply over the phone or to request an application.
Once you apply, the SSA will review your application and send you a letter informing you as to whether you were approved. If you do qualify for Extra Help, you need to enroll in a Medicare Part D prescription drug plan. You can do so right away as approval for Extra Help qualifies you for a Medicare special enrollment period.
To get prescription drug coverage, compare Medicare Part D plans in your state on the Medicare website and apply for one directly with the insurer.
Our partner Via Benefits can help you find and compare Medicare plans in your area.
Once you have a plan, you’ll have to provide the insurer with documentation that you’re receiving Extra Help. This documentation can include:
After you’ve provided documentation, you should pay no more than $3.35 for each generic drug or $8.35 for each brand-name drug, so long as it’s covered by your Medicare Part D plan.
Remember, income limits and assets change every year, as do personal situations. Just because you automatically qualify for an MSP or Medicare Extra Help one year does not mean you will automatically qualify the next. You’ll receive a notice from Medicare around the end of September is the SSA believes you no longer automatically qualify for Extra Help.
In this case, you will need to reapply for the program through SSA.gov or your local Medicaid office. Learn more about applying for Medicare.
Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.
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