“Extra Help” is Just That. Are You Eligible to Save on Drug Costs?

If you are currently enrolled or planning to sign up for Medicare, Extra Help can assist you in paying your prescription drug costs. Maybe you struggle to afford your Medicare Part D plan or wonder if your income qualifies you for additional aid. Seventy percent of people who qualify for Extra Help don’t even realize that they do! Regardless of your circumstances, we’ve outlined the basics of Extra Help and how you can check your eligibility.

What is Extra Help? 

Extra Help is a government program designed to help individuals—specifically those with low income or limited resources—pay for Medicare Part D. It can cover premiums, deductibles, and coinsurance associated with your prescription drug plan. Coverage varies, but the Social Security Administration estimates that it’s worth about $5,000 in savings each year.

State governments distribute Extra Help coverage. However, you must meet the federal government’s financial criteria to qualify. Limits on your annual income and available resources determine if you are eligible.

How Can I Qualify for Extra Help?

There are two ways to qualify for Extra Help. You may be automatically enrolled as part of a Medicare Savings Program. If you receive support with health care costs through any of these three programs, you also receive Extra Help:

  • Qualified Medicare Beneficiary (QMB) Program
  • Specified Low-Income Medicare Beneficiary (SLMB) Program
  • Qualifying Individual (QI) Program

But you don’t need to be on a Medicare Savings Program to get Extra Help. You can also qualify if you fall below a certain level of income and resources. Depending on whether you’re single or married, income and resource limits differ.

When the government looks at your resources, it considers money you have in a checking or savings account, bonds, and stocks. It does not factor in assets like a single car, your home, furniture, household items, burial plots, or savings for burial costs (up to $1,500).

Below are the Extra Help annual income and resource limits for 2020.

Medicare Part D Extra Help

Checking Your Level of Coverage

If you get Extra Help, there are varying degrees of coverage that can impact how much you pay at the pharmacy. To ensure you’re paying the right amount for Medicare Part D, your prescription drug plan provider can check your level of coverage. Sending any of these documents will give them the information they need:

  • Purple notice from Medicare saying you automatically qualify for Extra Help
  • Yellow or green automatic enrollment notice from Medicare
  • Extra Help “Notice of Award” from Social Security
  • Orange notice from Medicare saying your copay will change next year
  • Award letter from Social Security as proof of Supplemental Security Income

Likewise, if you are also on Medicaid, you can provide documentation proving you have Medicaid to check your coverage level. For example, you can send in

  • a copy of your Medicaid card,
  • a copy of a state document showing you have Medicaid,
  • a print-out from a state Medicaid electronic enrollment file,
  • or a screen-print from your state Medicaid system showing you have Medicaid.

Your plan provider must accept any of these documents as proof of your Extra Help eligibility. You will pay no more than the Low Income Subsidy (LIS) drug coverage cost for each of your prescriptions. In 2020, that was $3.60 for generic drugs and $8.95 for brand name drugs.

How to Enroll

In many cases, individuals are automatically enrolled in Extra Help. Once you send in any of the items listed above, for example, your drug plan provider will automatically enroll you. You may also be enrolled automatically as part of a Medicare Savings Program.

However, you can also visit your local Medicare office, call 1-800-MEDICARE, or reach out to your State Health Insurance Program (SHIP) in Ohio, Kentucky, or Indiana. Each of these sources can point you in the right direction!

Finally, note that if your resource or income levels change at any point, you can recheck your eligibility and enroll in additional aid as needed. Even if you aren’t sure how much coverage you qualify for, you’re encouraged to apply.

If you have questions about Extra Help, Medicare Part D, or how to find the right benefits, RetireMEDiQ is ready to help. To request information, call 1-866-407-5180 or visit https://www.retiremediq.com/schedule/.

RetireMEDiQ simplifies Medicare by providing guidance, evaluating your plan options, and helping you enroll in the right health care plan. Over 50,000 individuals have trusted them to deliver peace of mind.

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