Wednesday, May 15, 2024

What Is Extra Help For Medicare

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If you qualify for Extra Help and think youre paying the wrong amount, heres what you can do:

You may be able to get some money back if you:

  • Paid for prescriptions after you qualified for Extra Help
  • Arent in a Medicare drug plan

Keep your receipts with your prescription drug prices, and call Medicare’s Limited Income Newly Eligible Transition Program at1-800-783-1307. TTY users can call 711.

How Do You Know If You Have Medicare Part D

Your Medicare prescription drug plan would have sent you a card to keep in your wallet. Your pharmacist might also know.

Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.

You Might Still Have To Sign Up For A Part D Plan

You might not have to apply for Extra Help, but you do need to be enrolled in a Medicare prescription drug plan to get Extra Help coverage. So, if you donât have a Medicare prescription drug plan, you might need to sign up for it. In some cases, Medicare enrolls you in a plan. The notice will include instructions for you.

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See If You Qualify For Extra Help For Part D Prescription Drugs

Extra Help Part D income and resource levels


$2,309 per month/$27,705 per year


*Resources include the value of things you own. Examples of resources: Real estate , bank accounts and cash at home or anywhere else. Resources do not include the home you live in and one car.

Note: If you have income from working, your income could be higher, so we recommend applying to see if you qualify.

Get Help Paying For Prescription Drugs

Medicare Extra Help to Lower Your Drug Costs

Medicare Part D prescription drug coverage Extra Help assists Medicare clients, who qualify, for help to pay their prescription drug plan costs. It covers:

  • Donut hole/coverage gap

Caution: If you receive prescription coverage from an employer plan, you may not want to apply for this help. It could mean you would lose your employer health plan.

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Special Enrollment Periods If You Get Extra Help

I’m eligible for both Medicare and Medicaid.

What can I do?

Join, switch, or drop your Medicare Advantage Plan or Medicare prescription drug coverage.


One time during each of these periods:

If you make a change, it will take effect on the first day of the following month. Youll have to wait for the next period to make another change. You cant use this Special Enrollment Period from OctoberDecember. However, all people with Medicare can make changes to their coverage from October 15December 7, and the changes will take effect on January 1.

I qualify for Extra Help paying for Medicare drug coverage.

What can I do?

Join, switch, or drop Medicare drug coverage.


Most people with Medicare can only make changes to their drug coverage at certain times of the year. If you have Medicaid or receive Extra Help, you may be able to make changes to your coverage one time during each of these periods:

Help Paying Your Medicare Costs

To let you know you automatically quality for Extra Help, Medicare will mail you a purple letter that you should keep for your records. You don’t need to apply for Extra Help if you get this letter.

  • If you aren’t already in a Medicare drug plan, you must join one to use this Extra Help.
  • If you’re not enrolled in a Medicare drug plan, Medicare may enroll you in one so that you’ll be able to use the Extra Help. If Medicare enrolls you in a plan, you’ll get a yellow or green letter letting you know when your coverage begins, and you’ll have a Special Enrollment Period to change plans.
  • Different plans cover different drugs. Check to see if the plan you’re enrolled in covers the drugs you use and if you can go to the pharmacies you want.
  • If you have Medicaid and live in certain institutions or get home and community based services, you pay nothing for your prescription drugs.

Drug costs in 2022 for people who qualify for Extra Help will be no more than $3.95 for each generic drug and $9.85 for each brand-name drug. Look on the Extra Help letters you get, or contact your plan to find out your exact costs.

NOTE: When you apply for Extra Help, you can also start your application process for the Medicare Savings Programs. These state programs provide help with other Medicare costs. Social Security will send information to your state unless you tell them not to on the Extra Help application.

There are 4 kinds of Medicare Savings Programs:

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What Are The Medicare Extra Help Income And Resource Limits For 2022

You should apply if you think you qualify but your income exceeds the limits. You may still be eligible for Extra Help when your income is over the limit in some scenarios. These cases include when you 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. To be eligible for partial Extra Help, your resources must be equal to or below $15,510 as an individual or $30,950 with burial expenses as a married couple living together. Without burial expenses, the resource limit for an individual is $14,010 and $27,950 for a married couple.

To receive full Extra Help benefits, the resource limit with burial expenses for an individual is $9,900 and $15,600 for a married couple. Without burial expenses, the resource limit for an individual to receive full Extra Help benefits is $8,400 and $12,600 for a couple.

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The following examples count as resources:

  • Money in bank accounts

How Do I Apply For The Extra Help Program

Financial Help Options for Medicare

Some people automatically qualify for Extra Help. In these situations, you do not need to apply for the program.

Youre automatically enrolled in Extra Help if:

  • You have both Medicare and Medicaid
  • Youâre in a Medicare Savings Program
  • You receive Supplemental Security Income benefits

Medicare will mail you a letter on yellow paper if you automatically qualify for Extra Help. Keep this for your records.

If youre not enrolled in one of the programs above, you must apply to the Social Security Administration to receive Extra Help.

Three Ways to Sign Up for Extra Help

  • Apply at your local Social Security office
  • After you apply, Social Security will review your application before mailing you a letter to let you know if you qualify. Youll receive a letter printed on green paper if you qualify.

    After you qualify, you can pick your Medicare Part D drug plan. If you dont select a plan, Medicare will automatically enroll you in one.

    When you file your application for Extra Help, you can also apply for the Medicare Savings Programs. Social Security will send information to your state, and your state will then contact you and help you apply.

    Medicare Savings Programs are joint federal and state programs that help people with limited resources and income pay other Medicare costs, including your Part A and Part B premiums and, potentially, your deductibles and copayments as well.

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    More Member Resources And Services

    Cigna Case Management Get help managing chronic or new health issues.

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    Medication Therapy Management Support from Cigna Medicare clinical pharmacists.

    Pharmacy Network Save on copays with a Cigna preferred network pharmacy.

    Back to Member Resources and Services

    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.

    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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    How Can I Apply For Extra Help

    The Social Security Administration estimates that the Extra Help program is worth about $5,000 per year.

    You can apply for Extra Help right here, or by calling Social Security at 1-800-772-1213 . From there, you can apply over the phone, request a paper application, or schedule an appointment to apply at your local Social Security office.

    Please keep in mind that the Extra Help application does not enroll you in a Medicare Prescription Drug Plan, and that you do not need to be enrolled in a Medicare Part D Prescription Drug Plan in order to apply for Extra Help.

    If you need assistance completing your Extra Help application, check out these guidelines in English or in other languages via the SSAs Multilanguage Gateway.

    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

    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.

    Who Might Need Help With Their Lis

    Pin on Medicare info

    There are 4 groups of people who already have the LIS, but may need some help to keep it or to understand that their LIS is changing. We send them targeted notices on colored paper when there are changes to their LIS.

    1. People who wont automatically be eligible for the LIS

    Each September, we mail a notice on gray paper to people wholl no longer automatically get the LIS. This notice is a LIS application, and it includes a postage-paid pre-addressed envelope. These people may still qualify for the LIS, but they will need to send in a new application. The gray notice:

    • Tells the person why they no longer automatically qualify for the LIS
    • Encourages them to fill out and send in a LIS application

    2. People wholl have a change to their LIS co-payment

    In early October, we mail a notice on orange paper to people wholl qualify for extra help, but will have a change to their co-payment.

    3. People wholl be reassigned to a new plan

    In early November, we mail a notice on blue paper to people who qualify for the LIS, but will be reassigned to a new prescription drug plan starting on January 1st.

    We automatically reassign people who:

    • Qualify for the full premium subsidy
    • Are in a prescription drug plan thats raising the premium above the low-income premium amount
    • Were enrolled in their current plan by CMS

    Well also automatically reassign people who qualify for the LIS, if their prescription drug plan leaves the Medicare Program.

    4. People who chose their plan

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    Original Medicare Part A Hospital

    • Original Medicare Part A Hospital and Part B Medical: Fee-for-service coverage under which the government pays your health care providers directly for your Part A and/or Part B benefits.
    • Medicare Supplement : Sold by private insurance companies to fill gaps in Original Medicare coverage. Others may have coverage through a retirement health plan or Medicaid.
    • Prescription Drug Coverage: Sold by private insurance companies to fill gaps in Original Medicare coverage. Others may have coverage through a retirement health plan or Medicaid.

    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.


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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

    When Can You Submit Your Application

    Medicare Matters: What Counts as Income?

    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.

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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.

    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:

    • Real estate other than your primary residence

    Medicare doesnt consider the following resources when it comes to eligibility:

    • 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.

    If the amount of Extra Help youre receiving changes, youll get a notice on orange paper with your new copayment amounts. If you dont get any notices in the mail, you can expect to receive the same level of assistance with prescription drug costs that you got the previous year.

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    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:

    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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