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How To Qualify For Extra Help With Medicare Part D

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How To Apply For Extra Help With Medicare

How to Lower Medicare Part D Costs with Extra Help | Boomer Benefits

To apply for Extra Help, you can fill out Form SSA-1020 on the Social Security website. You can also call Social Security to apply over the phone or visit your local Social Security office to apply in person.

Social Security will mail a letter to you, informing you of whether you qualify for Extra Help. You can choose a Part D prescription drug plan after you qualify for Extra Help. If you havent qualified, you can still look for a Part D plan that fits your budget and includes your prescriptions in the formulary.

What Is Extra Help For 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 or Medicare Part B . 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?

What Are The Benefits Of Extra Help And Epic

Those approved for full Extra Help, a Medicare Savings Program or a Medicaid Spenddown do not have to pay any EPIC fees. EPIC will continue to pay Medicare Part D plan premiums for LIS members, and those with Full LIS in enhanced plans or Medicare Advantage plans up to the basic amount after Medicare premium subsidization.

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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

Do You Automatically Qualify For Extra Help

Medicare Part D: What is Extra Help?

You automatically qualify for Extra Help if you have any one of the following:

  • Supplemental Security Income and Medicare
  • Medicaid and Medicare
  • 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

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Medicare Supplement Insurance Plans

1Refer to your Evidence of Coverage for additional details on extra help/Low Income Assistance . Search for plans in your area and view the LIS premium chart located on the plans detail page. The chart will show you what your monthly plan premiums would be if you get extra help.

  • Customer Plan Links
Medicare Advantage Policy Disclaimers

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All clinical products and services of the LivingWell Health Centers are either provided by or through clinicians contracted with HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. or employees leased by HS Clinical Services, PC, Bravo Advanced Care Center, PC , Bravo Advanced Care Center, PC and not by Cigna Corporation. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. All pictures are used for illustrative purposes only.

Cigna contracts with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans in select states, and with select State Medicaid programs. Enrollment in Cigna depends on contract renewal.

Medicare Supplement Policy Disclaimers

Y0036_22_101121 | Page last updated 10/01/2021.

Can You Automatically Qualify For Extra Help

You can automatically qualify for Extra Help if you already receive assistance from another government program, including:

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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Benefits Of The Medicare Part D Extra Help/low

The Low-Income Subsidy program helps pay for a portion of Part D prescription drug plan costs, including Part D premiums, deductibles and copayments. Depending on your income and assets, you may qualify for the full subsidy or a partial subsidy. All beneficiaries who qualify for the LIS program are permitted to change Part D plans once a quarter for the first 3 quarters with an effective date of change being the first of the following month. In addition, one change can be made in the last quarter of the year, with the effective date being January 1. Beneficiaries who have been identified as at risk for opioid abuse, may be further restricted from changing plans.

In this section:

Do I Qualify For Extra Help

Part D Extra Help – How to – Applying for Medicare Part D Extra Help

According to, 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. Next, discover if you automatically qualify for Extra Help.

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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 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 . Moreover, you do not pay Part D late enrollment penalties.

How Is Epic Used With Medicare Part D

EPIC supplements Medicare Part D drug coverage for greater annual benefits and savings. When purchasing prescription drugs, the member shows both their EPIC and Medicare Part D drug plan cards at the pharmacy. After any Medicare Part D deductible is met, if the member has one, drug costs not covered by Part D can be submitted to EPIC for payment. The member will pay an EPIC co-payment ranging from $3 to $20 based on the cost of the drug. For example, if the EPIC member’s out-of-pocket drug cost is $100, the member will pay $20.

Please note that EPIC deductible members must first meet their EPIC deductible before they pay EPIC co-payments. This is in addition to meeting their Medicare Part D drug plan deductible should their Part D plan have one.

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Extra Help Income And Resource Qualifications

As of February 2021, published Understanding the Extra Help With Your Medicare Prescription Drug Plan. It states your resources and income must be limited to $14,790 for an individual or $29,520 for a married couple living together. Resources include things of value that you own, which may include the following:

  • Real estate
  • Bank accounts

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

What If I Dont Qualify For Medicare Extra Help

Medicare Extra Help &  Low Income Subsidy

If you dont qualify to receive Extra Help, there are still ways to save money. Your State Medical Assistance office or your State Health Insurance Assistance Program can provide you more information on payment assistance for prescription drug costs. You can look up your local Medicaid and SHIP offices here.

Here are other ways to reduce costs for Medicare Part D prescription medications:

  • Switch to a generic form of the prescription drug if available .
  • Ask your doctor about less expensive brand-name drugs.
  • Use a mail-order pharmacy, which may provide savings if youre ordering a larger quantity of medications.
  • Compare Medicare Part D coverage options to find plans with lower costs.
  • Find out if the pharmaceutical company that makes your medication offers help paying for it. Some manufacturers may offer discounts through pharmaceutical assistance programs.

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How Do I Prove Im Eligible For Extra Help

The Centers for Medicare & Medicaid Services started the Best Available Evidence policy to deal with Extra Help eligibility. BAE makes sure that people getting Extra Help arent charged too much or have higher copayments than youre supposed to.

According to CMS, all plan sponsors, like Cigna, must accept BAE sent by someone applying for Extra Help if they are eligible, even if Medicare records dont show it. Once youve sent Best Available Evidence to Cigna Medicare, we will ask CMS to change your status in their system.

Some acceptable forms of Best Available Evidence are:

  • A copy of your Medicaid card
  • A copy of a state document that shows you have Medicaid
  • A print-out from a state electronic enrollment file or from your state’s Medicaid systems that shows you have Medicaid
  • A screenprint from the State’s Medicaid systems showing Medicaid status
  • Any other document from your state that shows you have Medicaid
  • A document from your state that shows you have Medicaid and are getting home- and community-based services
  • Social Security Administration Award Letter
  • An Application Filed by Deemed Eligible confirming that the beneficiary is automatically eligible for extra help
  • The Social Security Office at between 7 am and 7 pm, Monday through Friday 325-0778)
  • Your local State Medicaid Office

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 Assets Are Included

Your assets include money that you have across all types of savings accounts, checking accounts, and investment accounts. Make sure to consider your retirement accounts like an IRA or 401, as well any stocks or bonds you own. Real estate that you own other than your primary residence also counts toward your total assets in most cases.

Your assets do not include your home, a car, a burial plot, furniture, or any other personal items. Life insurance policies are excluded and you can subtract $1,500 per person for burial expenses. You donât have to include any advance tax credits you get, such as for the earned income tax credit, or money you received for housing assistance. You can find a complete list of exemptions on the SSA website.

How Do I Know If Im Enrolled In Extra Help

Extra Help For Medicare Part D

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.

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Find Your Level Of Extra Help

Extra Help is a program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. If you get Extra Help but youre not sure if you’re paying the right amount, call your drug plan. Your plan may ask you to give information to help them check the level of Extra Help you should get.

Eligibility For Medicare Extra Help

To qualify for government help with the costs of your prescription drug coverage, you must have assets and personal resources that fall below specific limits. These limits may change each year. Countable personal resources include stocks, bonds, and money in a checking or savings account. These resources do not include property, vehicles, burial plot and other burial expenses set aside up to $1,500, furniture, and other household items.

You might qualify for Medicare Extra Help automatically

Certain beneficiaries automatically qualify and are enrolled in the Extra Help program. You may automatically qualify if you have Medicare Part A and Part B and meet any of the following conditions:

  • You have full Medicaid coverage.
  • You get help from your state Medicaid program with paying your Part B premiums.
  • You receive Supplemental Security Income benefits.

Once you are determined to be eligible for Medicare Extra Help automatically, you will qualify for the entire year. Even if you stop receiving Medicaid or certain other assistance during the year, you will continue receiving Extra Help for the remainder of the year.

You might have to apply for Medicare Extra Help

If you do not automatically qualify for the Low-Income Subsidy you can apply for it in either of these ways:

New To Medicare?

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Qualifications For Medicare Extra Help Program

To qualify for the Low-Income Subsidy you must meet the following requirements.

  • You have Medicare Part A and or Medicare Part B
  • LIve in one of the 50 states or the District of Columbia
  • As of 2020, you combined savings, investments and real estate are less than $29,160 if you are married or living with your spouse.
  • Your income is below $14,610 if you are not married or living with a spouse
  • You do not have to count your home, vehicles, personal possessions, life insurance, burial plots, burial contracts, or back payments from Social Security of SSI in those figures.
  • If your income exceeds the previous figures you may not qualify for Extra Help, however, you still can purchase a Medicare Part D prescriptions plan to help with the costs of medications
  • If you receive Medicare and Supplemental Security Income you should automatically qualify for the program
  • Should have both Medicare and Medicaid you should also qualify for the low-income subsidy

Ial Extra Help Program

Pin on Medicare

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.

  • 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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