What Do I Need To Know
Most of the questions on the application are about resources and income. If you are married and living with your spouse, the SSA needs to know this information about both of you. Family members, caregivers and other third parties can help you complete the application. The information below can help you decide if you are eligible and can assist you in completing the actual application for Extra Help. The worksheet is not an application.
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Medicare Premium: What Is It And How Does It Work
Your Medicare premium is the monthly payment you make to have a Medicare insurance plan. Medicare insurance has four parts: Part A , Part B , Part C , and Part D . You pay a different premium for each part of Medicare. Medicare Parts A and B are known as Original Medicare because the insurance coverage is provided directly through the Medicare program.
Premiums for Parts A and B are determined by and billed through Medicare. The premium for Part A can be up to $471 a month as of 2021,1 but you usually dont pay any premiums for Part A insurance . The estimated Part B premium for 2022 is $158.50.2
A Part C plan combines other parts of Medicare and can provide you with a broader range of benefits. These plans are sold through private insurance companies that are approved by Medicare. Premium rates vary depending on the type plan and where you live, but the average premium for 2022 Part C plans is $19.3
Medicare Part D plans are also provided through private insurance companies. The national average Part D premium is $33 for 2022.3 But depending on where you live and the type of plan you have, Medicare Part D costs will vary.
Once You Give Your Plan This Information Your Plan Must:
- Make sure you pay no more than the LIS drug coverage cost limit. In 2021, prescription costs are no more than $3.70 for each generic/$9.20 for each brand-name covered drug for those enrolled in the program. In 2022, these costs will be no more than $3.95 for each generic/$9.85 for each brand-name covered drug.
- Contact Medicare so we can get confirmation that you qualify, if it’s available. Your request can take anywhere from several days to up to 2 weeks to process, depending on the circumstances. Call us at 1-800-MEDICARE . TTY: 1-877-486-2048.
Be sure to tell your plan how many days of medication you have left. Your plan and Medicare will work to process your request before you run out of medication, if possible.
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What Is Medicare Extra Help
Prescription drug coverage is important for anyone who is eligible for Medicare. But the cost of this coverage stops many people from getting it.
The Extra Help program can help you pay for your Medicare prescription drug costs. In this article youll learn what Extra Help specifically covers and find out if you qualify for this program.
How Do I Apply For A Low Income Subsidy
You can apply for a low include subsidy by following three steps:
If you are automatically eligible for Extra Help, either do to your Medicaid enrollment or other qualifying program, you do not need to apply in order to receive the benefits of a low-income subsidy.
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Medicares Extra Help Program
At Humana Pharmacy®, we understand paying for your prescription medicines can add up quickly throughout the year. This is why we work hard to keep the cost of your medicines affordable by offering $0 copays on most generic 90-day prescriptions and finding low-cost alternatives for costly medicines.
However, for some, we understand that you need more help to stay on track with your care. So, we wanted to make sure you knew about Medicares Extra Help program. The Extra Help program provides added financial support to people with limited income and resources, as well as the following benefits:1
- $0 or reduced drug coverage premiums and lower out-of-pocket costs
- No coverage gap
- No late enrollment penalty for Medicare prescription drug coverage
How Can You Get The Extra Help
To get Extra Help with Medicare prescription drug costs, you must complete and submit this application. The Social Security Administration will review your application and send you a letter to let you know if you qualify for Extra Help. SSA will also send you information about the Medicare Prescription Drug Coverage and tell you what you should do next.
NOTE: To apply, you must live in one of the 50 States or the District of Columbia.
What Are The Income And Resource Limits For Extra Help In 2021
In 2021, the annual income limit for Extra Help for an individual is $19,140. For a married couple who is living together, the limit is $25,860. When your income is calculated, governmental assistance such as food stamps, housing assistance, and home energy assistance arent counted.
Even if your income is higher than the limits, you should still apply for Extra Help if you think you qualify. Some scenarios where youd still be eligible for Extra Help even though your income is over the limit include if you and/or your spouse:
- Provide financial support for other family members currently living with you
- Earn money by working
- Reside in Alaska or Hawaii
Resource limits also apply when determining your eligibility for Extra Help. Your resources must be equal to or below $14,610 as an individual or $29,160 as a married couple who are living together.
The following examples count as resources:
- Real estate
- Money in bank accounts
- Interest on money slated for use as burial expenses
Contact Social Security for a comprehensive list of excluded resources.
Medicare Extra Help: Eligibility Income Limits And How To Apply
If you need help with your prescription drugs, there is support available
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Individuals who have limited income and assets could qualify for assistance when it comes to paying for prescription drugs through Medicares Extra Help program.
This is thanks to a partnership between the Social Security Administration and the Centers for Medicare & Medicaid Services , there is support available for those individuals that need it.
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Levels Of Part D Extra Help
There are four categories of people who qualify for the Extra Help program. The categories are defined by the Medicare recipient’s income in relation to the Federal Poverty Guideline , or federal poverty level , or the previous year. In 2020, the FPG for a single person is an annual income of less than $12,760 . For larger family units , the figure goes up by $4,480 per person . FPG amounts go up slightly each year to find the current amounts for this year, see Nolo’s article on the federal poverty level.
The amount of Extra Help a beneficiary receives varies with the category.
Category One. This category includes individuals eligible for Medicaid whose income is under the FPG. They pay no premium or deductible, have no gap in coverage, and have reduced per-prescription copayments.
Category Two. This category includes individuals eligible for Medicaid but with incomes above the FPG. They pay no premium and have no coverage gaps, but pay a higher per-prescription copayment than other Medicaid recipients.
Category Three. This category includes individuals not eligible for Medicaid but with income less than 135% of the FPG. In 2020, this is income less than $1,435 a month for an individual and $1,940 a month for a couple. Assets must be less than about $10,000 . People who qualify pay no premium or deductible, have no gap in coverage, and have reduced per prescription copayments.
How To Ensure Youre Paying The Right Amount In Extra Help
If you think youre paying the wrong amount, call your Medicare Part D drug plan. Your plan may ask you to provide information to help them verify if the level of Extra Help you are receiving is correct. Here is a list of documents you can use to help prove you qualify for Extra Help:
- A purple notice from Medicare that says you automatically qualify for Extra Help.
- A yellow or green automatic enrollment notice from Medicare.
- An Extra Help Notice of Award from Social Security.
- An orange notice from Medicare that says your copayment amount will change next year.
- If you have Supplemental Security Income , you can use your award letter from Social Security as proof that you have SSI.
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How Does Medicare Extra Help Reduce Drug Costs
People who have Medicare Extra Help find that the amount by which it reduces prescription drug costs may vary.
The SSA estimate that Medicare Extra Help reduces prescription drug costs by about $5,000 a year for each recipient.
Medicare Extra Help reduces drug costs in several ways. It lowers the monthly premium for Medicare Part D. People that receive full Extra Help pay a $0 premium and do not have to meet a deductible.
In 2020, they also have a $3.60 copayment for generic drugs and an $8.95 copayment for brand-name drugs. After they reach $6,350, they no longer need to provide a copayment when buying medications.
Medicare Part D includes prescription medication copayments. As these may vary, the Part D copayment may be lower than the Medicare Extra Help copayment. Individuals with Extra Help pay whichever copay is lower.
If Youre A Family Member Caregiver Or Other Third Party
You can help Medicare beneficiaries apply for Extra Help with their Medicare prescription drug plan costs. If you assist someone with the application, you must answer the questions as if that person were completing the application. To find out if someone is eligible, Social Security will need to know the value of his or her savings, investments, real estate , as well as income. The SSA needs information about whomever you are helping and his or her spouse, if they are married and living together. The information in our To prepare: section, and The records youll need are: section, can help you with the application.You can help someone apply for Extra Help online by visiting the SSA website or calling the toll-free number to request the Application for Extra Help with Medicare Prescription Drug Plan Costs . You also can visit your local Social Security office for assistance.
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How Do I Know If Im Enrolled In Extra Help
Youll receive notice of your Extra Help status from the SSA. Notices are different colors depending on your status:
- Purple notices mean youre automatically qualified.
- Yellow or green notices mean youre automatically enrolled.
- Gray notices mean youre no longer automatically qualified.
- Orange notices mean the amount of Extra Help youre getting is changing.
Its important to keep an eye on your mail and keep track of the notices you get from Social Security. Reading all communication ensures you wont be surprised by any costs and will have time to prepare for any changes.
Who Qualifies For Medicare Extra Help How To Apply
Most Medicare beneficiaries receive coverage for hospital visits through Medicare Part A and typical medical services through Medicare Part B. They may also opt into Medicare Part D, an optional portion of Medicare specifically for prescription drug coverage. But medications arent cheap, and neither are insurance premiums and deductibles, so individuals with limited income can apply for financial assistance through the Medicare Extra Help program.
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Medicare Part D Costs After Medicare Extra Help By Marital Status
Medicare Extra Help for single people
Income up to or at the federal poverty level: $0 deductible, $1.35 copay for generic drugs, and $4.00 copay for brand-name drugs up to the out-of-pocket threshold $0 for either drug type above the out-of-pocket threshold
Income up to or at 135% of the federal poverty level and resources greater than or equal to $9,470: $0 deductible, $3.95 copay for generic drugs, and $9.85 copay for brand-name drugs up to the out-of-pocket threshold $0 for either drug type above the out-of-pocket threshold
Income below 150% of the federal poverty level and resources below $14,790: $99 deductible, $3.95 copay for generic drugs, and $9.85 copay for brand-name drugs up to the out-of-pocket threshold 15% coinsurance for either drug type above the out-of-pocket threshold
Medicare Extra Help for couples
If you make 150% of the FPL or more, then you don’t qualify for Medicare Extra Help.
What If I Need Help Completing The Form
Family members, caregivers, and third parties can help you complete the form. Social Security also can help answer your questions. Just call us at 1-800-772-1213. If youre deaf or hard of hearing, please call our TTY number at 1-800-325-0778. You also may visit your local Social Security office for assistance.
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Supplemental Security Income Benefits
SSI is a cash benefit paid by Social Security to people with limited income and resources who are blind, 65 or older, or have a disability. SSI benefits arent the same as Social Security retirement benefits. You may be able to get both SSI benefits and Social Security benefits at the same time if your Social Security benefit is less than the SSI benefit amount, due to a limited work history, a history of low-wage work, or both. If youre eligible for SSI, you automatically qualify for Extra Help, and are usually eligible for Medicaid.
What If My Income Changes And I No Longer Qualify For Medicare Extra Help
Your eligibility for Medicare Extra Help lasts for an entire year. But Social Security will review your eligibility periodically.
To do this, the SSA will contact you with a form. These forms typically get sent out in the fall. If you dont receive one, you can count on your Extra Help staying the same in the coming year.
If you do get a form, youll need to fill it out within 30 days and send it back. If you dont, your coverage will end in January of the upcoming year. For example, if you receive an eligibility review form from Social Security on September 14, 2021, and dont send it back by October 14, your Extra Help will end in January 2022.
When you return the form, a few things might happen. Depending on changes to your income, your Extra Help could:
- stay the same
The SSA will notify you of this decision. If you no longer qualify or qualify with higher out-of-pocket costs, youll get a letter explaining the changes. You might need to start paying premiums to keep your Part D plan.
Even if you no longer qualify for Extra Help, you might still be able to get help paying your Part D costs. You can contact your states Medicaid office or State Health Insurance Assistance Program for information on programs that can help you pay for your prescriptions.
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What Doesnt Count As Income And Resources
Federal law requires that states exclude certain types of assets. These are some of the main things that dont count:
|Doesnt Count as a Resource|
|Items that cannot be easily converted to cash such as furniture and jewelry|
|Burial plot and burial funds valued up to $1,500 for individuals and $3,000 for couples|
|Life insurance that has less than $1,500 in cash value|
Who Qualifies For Extra Help
You can qualify for Extra Help if you are entitled to Medicare Part A and/or Part B, live in any of the 50 states or Washington, D.C., are not incarcerated and have both limited resources and limited income.
Receiving assistance from the government programs listed below can also qualify you to automatically receive Extra Help.
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Are There Resource Limits
The short answer is yes.
Your income and resources both need to fall below a certain amount in order for you to qualify for Extra Help. Resources are things like savings accounts, stocks, IRAs, bonds, and real estate thats not your primary home.
Your home, your car, and any valuables you own dont count as resources. Medicare also wont count large payments, such as the payout from a life insurance policy or a tax refund.
To qualify in 2021, your resources cant exceed $14,790 as an individual. If youre married, you need to have combined resources of less than $29,520 to qualify.
Medicare Extra Help For Low Income Persons
For individuals who receive Part D prescription drug coverage and are low-income, there is assistance available for the costs of deductibles and co-pays. This Extra Help is also known as the Low Income Subsidy .
Who is eligible?To receive Extra Help, persons must be eligible for Medicare Part D and have income less than 100% of the Federal Poverty Level for a full benefit or less than 150% of the Poverty Level for a partial benefit.
What are the benefits?Benefits vary based on the recipients income and on living situation. In general, Extra Help will pay for a persons monthly drug plan premium for an Extra Help approved plan. It will also pay the annual deductible amount , though it will leave $99 deductible for partial subsidy recipients to pay out of pocket. Extra Help will also cover all drugs in the coverage gap, or doughnut hole, or 85% of drug costs for partial subsidy recipients. Individuals will pay $3.95/generic or multi-source drug and $9.85 for other drugs.
In the standard benefit, when Medicare beneficiaries have spent $4,430 in 2022 in prescription costs, the coverage gap begins however, individuals who are receiving Extra Help will continue to pay co-payments between $3.95 for generic or multisource drugs with a retail price under $79 and 5% for those with a retail price greater than $79. For brand-name drugs, beneficiaries would pay $9.85 for those drugs with a retail price under $197 and 5% for those with a retail price over $197.
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