Why Should I Apply Online
The online application is secure and offers several advantages. It takes you through the process step-by-step with a series of self-help screens. The screens will tell you what information you need to complete the application and will guide you in answering the questions fully. You can apply from any computer and at your own pace. You can start and stop at any time during the process, so you can leave the application and return later to update or complete any of the required information. The SSA is careful to protect your personal information.
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.
Having Trouble Paying Your Prescription Drugs
If you qualify for Extra Help and join a Medicare drug plan, you’ll:
- Get help paying your Medicare drug plan’s costs.
- Have no late enrollment penalty.
You automatically qualify for Extra Help if you have Medicare and meet any of these conditions:
- You have full Medicaid coverage.
- You get help from your state Medicaid program paying your Part B premiums .
- You get Supplemental Security Income benefits.
Drug costs in 2019 for people who qualify for Extra Help will be no more than $3.40 for each generic drug and $8.50 for each brand-name drug.
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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
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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What Does Extra Help Cover
Depending on your situation, Extra Help will cover a portion of your drug costs or all of your drug costs.1 This assistance can save you as much as $5,000 a year.2
The Extra Help program only covers costs related to a Medicare prescription drug plan . It does not help with costs from other parts of Medicare .
If you need a refresher on the parts of Medicare, see our Medicare 101 Guide.
Extra Help also eliminates the late-enrollment penalty for not getting Part D drug coverage when you were first eligible. However, it doesnt affect the Part B late-enrollment penalty.
What Is This Application
This is an application for Extra Help with Medicare prescription drug costs. It does not enroll you in a Medicare prescription drug plan. To get that coverage, you will have to enroll directly with an approved Medicare prescription drug plan. If you need information about Medicare Prescription Drug plans or how to enroll in a plan, call Medicares toll-free number 1-800-MEDICARE or visit www.medicare.gov.
Medicare Extra Help Income Limits
- Extra Help can help you pay for Medicare Part D if you have limited income and resources.
- Part D is the part of Medicare that covers prescription drugs.
- As an individual, you must make less than $19,320 and have less than $14,790 in resources to qualify.
- If youre married, you and your spouse will need to make less than $26,130 in total income and have less than $29,520 in combined resources.
If you need help paying for the costs of your Medicare Part D prescription drug plan, you might qualify for assistance through a program called Extra Help. To qualify for Extra Help, you need to meet certain financial requirements.
Read on to learn about Medicares Extra Help program, including this years income limits, how to qualify, enrollment information, and more.
When you have a Medicare Part D plan, youre responsible for monthly premiums, deductibles, copayments, and coinsurance amounts.
Medicare Extra Help can help you pay some or all of those costs.
The program is overseen by the Social Security Administration and is based on income. The SSA estimates that program participants can save as much as $5,000 per year.
Proof You Have Medicaid And Live In An Institution Or Get Home
- A bill from an institution . Or, a copy of a state document showing Medicaid paid for your stay for at least a month.
- A print-out from your states Medicaid system showing you lived in the institution for at least a month.
- A document from your state that shows you have Medicaid and are getting home- and community-based services.
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Competition: Extra Help Vs Humana
Extra Help is not Medicare insurance but a financial assistance program for Medicare members who have trouble affording their Prescription Drug Plan costs. To get Medicare insurance for prescription drugs, most Medicare Advantage plans offer drug coverage, and many insurers offer Stand-alone Prescription Drug Plans.
To qualify for Extra Help, youll have to choose a Prescription Drug Plan. Check out Humana, which offers Medicare plans in 85% of U.S. counties, the most of any Medicare insurer. Humana offers three types of Stand-alone Prescription Drug Plans, including the Humana Basic Rx Plan, which is ideally suited for people who qualify for Extra Help. Premiums in this plan range from $19.70 to $45.00 per month many drugs across tiers have $0 or very low copayments.
Extra Help is a financial assistance program for people who need help paying for prescription drug coverage and qualify based on income and assets. To use these subsidies, you must enroll in a Medicare Prescription Drug Plan. For help choosing a Prescription Drug Plan, check out our round-up of the Best Medicare Part D Providers.
What Services Does The Partnership Provide
- Medicare and Medicaid information and education
- Help with original Medicare eligibility, enrollment, benefits, complaints, rights and appeals
- Explain Medicare Supplemental insurance policy benefits and comparisons
- Explain Medicare Advantage and provide comparisons and help with enrollment and disenrollment
- Explain Medicare Prescription Drug coverage, help compare plans and search for other prescription help
- Information about long-term care insurance
The partnership also helps with the following programs. Benefit Counselors are specially trained to help you understand all the fine print to find and apply to a plan that works for you. They advocate for you with these programs and help you get the services you need.
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What Is The Texas Health Information Counseling And Advocacy Program
If you are eligible for Medicare, the Texas’ Health Information, Counseling and Advocacy Program can help you enroll, find information and provide counseling about your options. This partnership between the Texas Health and Human Services system, Texas Legal Services Center and the Area Agencies on Aging trains and oversees certified benefits counselors across the state.
Can You Automatically Qualify For Extra Help
You can automatically qualify for Extra Help if you already receive assistance from another government program, including:
- a Medicare savings program that helps you pay your Part B premiums
- Supplemental Security Income benefits
As a participant of one of these programs, youll still need to be enrolled in both parts of original Medicare, but you wont need to apply separately or submit income information again. Youll be automatically qualified for the Extra Help program.
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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|
Extra Help For Prescription Drug Coverage
Extra help for prescription drug coverage is available for people with Medicare who have limited income and resources. If eligible for extra help, Medicare will pay for almost all prescription drug costs. Extra help provides a subsidy based on the amount of income and resources a person has.
Full Subsidy Benefits from Extra Help:
- Full premium assistance up to the premium subsidy amount
- Nominal cost sharing up to out-of-pocket threshold
- No coverage gap
Other Low Income Subsidy Benefits from Extra Help:
- Sliding scale premium assistance
- Reduced coinsurance
- No coverage gap
An individual who has Medicare and Medicaid does not need to apply for extra help from Social Security. An individual who is eligible for the Medicare Savings Program does not need to apply for extra help from Social Security. The MSP-eligible individual’s information is sent to CMS automatically for the extra help.
Eligibility specialists ask, “Can I screen you for eligibility for Medicare Savings Program since certification would include eligibility for extra help?”
If the caller does not want to be screened for MSP, refer the caller to the Centralized Benefit Services, 1-800-248-1078, for completion of subsidy application.
If an individual thinks personal information is being misused, call 1-800-MEDICARE .
Apply for extra help or get more information about extra help subsidy by calling Social Security at 1-800-772-1213 or visiting www.socialsecurity.gov.
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How Do I Apply
To apply, youll need to complete Social Securitys application by:8
- Applying online
- Applying at your local Social Security office
If you need additional support with completing this application, a caregiver can help on your behalf or by calling the number above. Once you apply, your application will be reviewed by Social Security, and then they will send you a letter to let you know if you qualify for Extra Help.
Find Out If You Qualify
You might be eligible if you have an annual income under $20,000 and have less than $15,000 in assets. However, there are some exceptions.
Your assets may include bank accounts, savings bonds, mutual funds, Individual Retirement Accounts , and any other cash at home or anywhere else. Include the things you own by yourself, with your spouse, or with someone else. Do not count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts, or back payments from Social Security or SSI.
Find out if you might be eligible for benefits below.
DISCLAIMER: This quiz does not replace the official enrollment process and uses Partial Extra Help numbers to qualify the results. Those that may be eligible for Full Extra Help will need to contact their State Health Insurance Program Center. Eligibility does not guarantee enrollment into the program.
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What Is The Income Limit
To qualify for Extra Help, your annual income must be limited to $19,140 for an individual or $25,860 for a married couple living together. Even if your annual income is higher, you may still be able to get some help.Some examples where your income may be higher and you can still get Extra Help include if you or your spouse:
- Support other family members who live with you.
- Have earnings from work.
- Live in Alaska or Hawaii.
Alternative Medicare Assistance Programs
Programs outside of Medicare that can help pay premiums are generally for Medicare Part D plans. Depending on the state you live in, you may be able to get help with paying your Part D premiums through State Pharmaceutical Assistance Programs . These programs provide assistance to adults with disabilities and low-income seniors. States that offer Medicare premium assistance for Part D insurance make their own rules on who can qualify.
Some drug manufacturers also offer help with prescription drug costs, but this is for the cost of medicines instead of the actual premium for your Part D plan. If youre a senior citizen, have limited income, or a disability, you may qualify for discounted or free prescribed medicines through Patient Assistance Programs .
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Medicare Extra Help: Eligibility Income Limits And How To Apply
If you need help with your prescription drugs, there is support available
- Medicare Part A and Part B coverage.Are vision and dental services covered?
- Medicare Part C and Part D coverage.Who is eligible?
- Stimulus Check Updates.4th Stimulus Check Update: The states expected to receive new checks
Individuals who have limited income and assets could qualify for assistance when it comes to paying for prescription drugs through Medicare’s 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.
Do I Qualify For Help With Medicare Premiums
Tips on How to Pay Your Medicare Premiums
- Pay on time to avoid coverage cancellation
- Sign-up for automatic bank payments if your Medicare Part B premiums arent automatically deducted from Social Security
- If you get Medicare Advantage through a private insurance company, contact the company if you think you will miss a paymentcompanies have their own rules on how many payments you can miss before your insurance is cancelled
You may qualify for help with paying your premiums through Medicare Savings Programs if you:
You must contact your state Medicaid office if you think you could qualify for help with paying your Medicare insurance. Even if your income is slightly higher than the limits, you can still be eligible for full or partial premium assistance.
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When Can You Submit Your Application
This service is available during the following hours :
Monday through Friday: 5:00 AM 11:00 PMSaturday: 5:00 AM 9:00 PMSunday: 8:00 AM 8:00 PMHolidays: 5:00 AM 9:00 PM
* Social Security accepts applications during certain hours. We recommend that you begin at least one hour before the latest time listed above to ensure your application will be processed.
If you need help completing this application, to find a local agency in your community, or call Social Security toll-free at 1-800-772-1213.
Ial Extra Help Program
Partial Extra Help supports people who are on Medicare. If you have less than $19,320 inannual income as an individual or $26,130 as a couple , you may be eligible.
Please note: Most PAN grantees may only be eligible for Partial Help. People eligible for full coverage are almost always automatically enrolled.
PARTIAL EXTRA HELP BENEFITS*
- No monthly premium or premium based on a sliding scale
- $92 annual deductible
- Co-pay for the plans formulary drugs is 15% or the plans co-pay, whichever is less
- Catastrophic co-pay is no more than 5% of the drug cost.
Extra Help cost savings comparison
*2021 numbers** Assumes drug falls into the 15% co-pay category
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What Is The Medicare Low
Eligible beneficiaries who have limited income may qualify for a government program that helps pay for Medicare Part D prescription drug costs.
Medicare beneficiaries receiving the low-income subsidy get assistance in paying for their Part D monthly premium, annual deductible, coinsurance, and copayments. Also, individuals enrolled in the Extra Help program do not have a gap in prescription drug coverage, also known as the coverage gap, or the Medicare donut hole. The amount of subsidy depends on the individuals income compared to the Federal Poverty Level and resource limitations set by the Social Security Act.
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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What Does Medicare Extra Help Pay For
If you have Medicare, youre eligible for Medicare prescription drug coverage, also called Medicare Part D. But there are costs associated with this prescription drug coverage, including copays and deductibles. Thats where Medicare Extra Help comes in.
If you have limited income and savings, Medicare Extra Help can cover prescription drug copays and prescription plan premiums.
Medicare Extra Help may provide up to $4,900 of assistance annually if you qualify. This program is limited to prescription drug coverage. If you need help paying for other parts of Medicare, like Medicare Part A or Medicare Part B , there are other programs funded by some states that may be able to assist you.
Medicare Extra Help also doesnt apply to Medicare Advantage or Medigap programs.
- real estate aside from your primary residence
The Extra Help resource limits for 2021 are:
- Individual: $14,790