Extra Help Medicare Part D

What is Extra Help for Medicare Part D?

Extra Help Medicare Part D

Extra Help for Medicare Part D is a program to help people with limited income and resources pay Medicare prescription drug costs. For example, Extra Help can help pay your Medicare Part D premiums, deductibles, and copayment costs. To join a Medicare Part D drug plan, you must have Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). However, you must have both Part A and Part B to join a Medicare Advantage plan. Now that you know Extra Help pays for your prescription drug costs, how do you qualify?

Do I Qualify for Extra Help?

According to SSA.gov, to qualify for Part D Extra Help, you must be receiving Medicare and have limited resources and income. Furthermore, you must reside in one of the 50 States or the District of Columbia. As MedicareBob shows in his video, Extra Help is not available in Puerto Rico, U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. In this video, Robert Bache showed income requirements to qualify for Extra Help in 2019.

Do You Automatically Qualify For Extra Help?

You automatically qualify for Extra Help under the following three conditions: 

  • You have Medicare and Supplemental Security Income (SSI)
  • Have Medicare and Medicaid
  • You’re in a Medicare Savings Program

If you meet any of the above conditions, Medicare will send you a PURPLE notice. We advise you to keep this “Deemed Status Notice.” You do not need to apply for Extra Help. Then provide your Medicare Part D plan this document. It proves you qualify for Extra Help.

Furthermore, you can provide Medicare Part D with the following documents as proof that you qualify for Extra Help:

  • A yellow or green automatic enrollment notice from Medicare
  • Extra Help “Notice of Award” from Social Security
  • An orange notice from Medicare that says your copayment amount will change next year
  • Your award letter from Social Security that you have SSI

Extra Help Income and Resource Qualifications

As of March 2020, SSA.org published Understanding the Extra Help With Your Medicare Prescription Drug PlanIt states your resources and income must be limited to $14,610 for an individual or $29,160 for a married couple living together. Resources include things of value that you own, which may include the following:

  • Real estate (other than your primary residence)
  • Bank accounts
  • Stocks
  • Bonds
  • Mutual Funds
  • IRAs
  • Cash

On the other hand, resources that do not count include the following:

  • Your primary residence
  • Personal possessions such as jewelry or home furnishings
  • Your vehicle
  • Property you need for self-support, such as rental property or land you use to grow produce for home consumption
  • Non-business property essential to your self-support
  • Life insurance polices
  • Burial expenses

Benefits of Extra Help

The amount of Extra Help you receive depends on your income and resources. You can receive either a full-subsidy or a partial subsidy. Anyone who meets State Medicaid financial eligibility qualifies for Full Low-Income (LIS) Subsidy and pays no premiums, no deductible, no copay, and no coinsurance. Furthermore, anyone who qualifies for Full LIS will pay no more than $8.95 copay for brand-name and $3.60 copay for generic drugs.

In addition to lower out-of-pocket expenses, Medicare beneficiaries with Extra Help have three Special Enrollment Periods. You can join or switch Medicare Part D drug plans every three months from January through September. Furthermore, you can join or switch during the Annual Enrollment Period (Oct 15 – Dec 7). Moreover, you do not pay any Part D late enrollment penalty.

How to Apply for Extra Help Medicare Part D?

Senior Using Smartphone

You can apply for Extra Help online. To complete the application, you will need to provide SSA.gov information about your income and resources. Documents that can help you include the following:

  • Social Security card
  • Bank account statements
  • Individual Retirement Acounts, stocks, bonds, mutual funds
  • Tax returns
  • Payroll slips
  • Your most recent Social Security benefits award letters or statements for Railroad Retirement benefits, Veterans Benefits, pensions and annuities

Apply for Extra Help at Social Security Administration website.