Who Qualifies For Medicare Part D Extra Help
Eligibility for Medicare Part D Extra Help is based on your income and assets, and the limits change yearly. In 2021, you may be eligible for Medicare Part D Extra Help if:
- Individual: your annual income no more than $19,320, and the value of your assets is no more than $14,790.
When counting your resources to determine eligibility for Extra Help, Medicare includes items such as:
- Bank accounts
- Real estate other than your primary residence
Medicare doesnt consider the following resources when it comes to eligibility:
- Your house
- One vehicle
- Burial plot and up to $1,500 for burial costs if youve set aside money for this purpose
- Personal or household items
You may automatically qualify for Extra Help if you have Medicare and also:
- Receive full Medicaid coverage .
- Are enrolled in a Medicare Savings Program, which pays for your Part B premium.
- Receive Supplemental Security Income benefits.
Even if you automatically qualify this year, you may not next year if your income or resources change, or the Extra Help program adjusts its eligibility limits. Youll receive a notice in the mail on grey paper by the end of September if this is the case. Even if you get this, you may still qualify, but youll need to reapply.
How Can I Find A Plan That Helps Me Save On Medicare Part D Costs
Even if you dont qualify for the Extra Help this year, one of the simplest ways you can reduce prescription drug costs is by taking the time to compare and research plan options. Remember, Medicare Part D costs often vary from plan to planeven when the prescription drugs being covered are exactly the same. Each Medicare plan that covers prescription drugs typically places covered medications into different cost tiers, and your copayment and coinsurance costs will depend on which tier your prescriptions fall onto. Typically, medications on higher tiers have higher cost sharing amounts.
The Medicare Advantage and Prescription Drug Annual Election Period runs from October 15 to December 7 each year and is your yearly opportunity to take stock of your prescription coverage and make changes if needed. During this time, you can enroll in Part D coverage, switch plans, or drop your prescription drug coverage entirely.
Would you like to browse plan options now? You can get started by clicking the Compare Plans button on this page simply enter your prescriptions to filter your search and only display plan options that cover your medications.
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About The Medicare Savings Program
Indiana helps eligible, low-income beneficiaries pay for Medicare with the Medicaid program. Medicaid is a health care program that helps pay for medical services for people who meet specific requirements.
You may be eligible depending on your income and the value of things you own :
Assets are things you own, such as checking and savings accounts, certificates of deposit, cash value of life insurance, stocks and bonds. Some things you own don’t count toward your asset limit, such as your home and furnishings, your car, burial plots, and, at least $1,500 in life insurance.
These limits are guidelines. The only way to know for sure if you are eligible is to apply.
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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.
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How Medicare Extra Help Works
Once you have a plan, youâll have to provide the insurer with documentation to prove that you are receiving Extra Help. The documents that count as proof include
A purple, yellow, or green notice of automatic qualification from Medicare
An Extra Help award notice from the SSA
Your Supplemental Security Income award letter
A copy of your Medicaid card
Once you provide documentation, you will immediately start paying the lower Extra Help drug prices.
Remember that the income and asset limits for Extra Help change every year. Just because you qualify one year does not mean you will qualify the next. Youâll receive a notice from Medicare around the end of September if the SSA believes you no longer automatically qualify for Extra Help.
In this case, you will need to reapply for the program through SSA.gov or your local Medicaid office.
What Should I Do If I Get This Notice
Medicare will mail you a purple letter to let you know you automatically qualify for Extra Help. Keep this for your records. You dont need to apply for Extra Help if you get this letter. If you dont already have Medicare drug coverage, you must get it to use this Extra Help. If you dont have drug coverage, Medicare may enroll you in a separate Medicare drug plan so that youll be able to use the Extra Help. If Medicare enrolls you in a plan, youll get a yellow or green letter letting you know when your coverage begins, and youll have a Special Enrollment Period to change plans if you want to enroll in a different plan than the one Medicare enrolled you in.
What Is The Medicare Part D Extra Help Program
The Medicare Extra Help program is for people who need financial assistance with their Medicare Part D coverage. Prescription drug coverage is available through either a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan . Both types of plans are available through Medicare-approved private insurance companies.
If youre eligible for the Medicare Extra Help program, the level of assistance you get depends on your income and financial resources. The program caps the costs you pay for covered generics and brand-name medications. In 2021, enrollees who receive Extra Help wont pay more than $3.70 for each generic medication and $9.20 for each brand-name medication. In addition, depending on your income and assets, you may get help with Medicare Part D premiums and deductibles.
How Do I Apply Extra Help
You can apply for Extra Help in a few different ways.
One of the quickest ways is to apply online. The SSA has an online application you can use to get started right away. You can also mail in your application.
If you need assistance with your application you can:
- Apply by phone at 800-772-1213 or 800-325-0778. You can call Monday through Friday between 7 a.m. and 7 p.m.
- Apply at your local Social Security office.
- Apply at your local Medicaid office. This option is only available if you qualify for Medicaid.
No matter how you apply, youll need to be prepared to give the SSA information about your finances. This can include:
- recent pay stubs
- bank statements, including for any savings accounts
- stock certificates or investment statements
- information about your pension
- recent tax returns
Once your application is approved, youll need to enroll in a Part D plan. Medicare considers your approval for Extra Help a qualifying event for a special enrollment period, so you dont need to wait for a standard enrollment period.
This means you can select a Part D plan as soon as your Extra Help is approved. You can shop for Part D plans directly on the Medicare website.
You dont need to apply separately if youre already enrolled in Medicaid, an MSP that pays your Part B premiums, or in SSI. In these cases, youll be automatically enrolled in Extra Help when you join a Part D plan.
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How To Apply For Extra Help With Medicare
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.
Interested In More Information
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.
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Do I Qualify For Extra Help With Medicare
You can qualify for the Extra Help program if both of these are true:
- Your income is $19,140 a year or less. Common examples of income are wages, pensions, and Social Security benefits. If youre married, your spouses income is counted, too, and the income limit goes up to $25,860.
- You have $14,610 or less in resources. Your resources are the things you own and how much they are worth. Common examples are your bank accounts, retirement accounts s), and any cash you have. Your home and vehicle are not counted. If youre married, the resource limit for Extra Help is $29,160.
Even if your income and resources are above these limits, you can still apply for the Extra Help program, because you might qualify for partial assistance. You may also be able to receive Extra Help if you meet one of these exceptions:
- You are supporting other family members in your household.
- You live in Alaska or Hawaii.
- You are an American Indian or Alaska Native.
If you have Medicaid or Supplemental Security Income , you are automatically included in the Extra Help program.
Am I Eligible For Extra Help
Your income and resources determine the level of help you receive. Youll automatically receive Extra Help if you have both Medicare and Medicaid, a Medicare Savings Program, or Supplemental Security Income, or Medicare only but also a limited income .
To be eligible for Extra Help, your income in 2021 cannot exceed $19,320 for an individual or $26,130 for a married couple living together. In addition, resources must not exceed $14,790 for an individual and $29,520 for married couples .
Resources do not include your car or home, but do include stocks, bonds, and bank accounts. A recent law excludes some additional resources, making it easier for more beneficiaries to get Extra Help: life insurance policies dont count as resources, and financial assistance you receive from friends or relatives to help pay your household expenses is not considered income. .
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What Does Medicaid Cover
- If you have Medicare and full Medicaid coverage, most of your health care costs are covered. You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan.
- If you have Medicare and/or full Medicaid coverage, Medicare covers your Part D prescription drugs. Medicaid may still cover some drugs that Medicare doesnt cover.
- People with Medicaid may get coverage for services that Medicare doesnt cover or only partially covers, like nursing home care, personal care, transportation to medical services, home- and community-based services, anddental, vision, and hearing services.
PACE is a Medicare and Medicaid program offered in many states that allows people who otherwise need a nursing home-level of care to remain in the community. To qualify for PACE, you must meet these conditions:
- Youre 55 or older.
- You live in the service area of a PACE organization.
- Youre certified by your state as needing a nursing home-level of care.
- At the time you join, youre able to live safely in the community with the help of PACE services.
What Does Medicare Part B Pay For
When you turn 65, you become eligible to receive Medicare insurance benefits. Original Medicare offers Part A and Part B. These benefits are offered to all Medicare recipients. When signing up for Medicare, it is critical to know what coverage you can expect and what options you may have.
What is Medicare Part B and What Does it Cover?Medicare Part A and Part B are designed to cover inpatient and outpatient expenses. Part A is designed specifically for inpatient stays in hospitals, skilled nursing facilities, and hospice care. Part B, on the other hand, provides coverage at outpatient facilities and doctor offices and is designed to cover medically necessary services and preventive services.
Medically necessary services are those that are required to diagnose or treat a specific illness, injury, or condition. These services must also meet the accepted standards of medical practice. These services may include imaging, such as an x-ray, MRI, or CT scan, that may be needed to evaluate an injury or to examine your body for additional damage following an accident.
Part B also does not cover elective procedures, massage therapy, acupuncture, or cosmetic surgery, as these procedures are often not deemed to be medically necessary by the insurance company.
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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.
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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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.