Tuesday, February 27, 2024

What Is Extra Help From Medicare

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Do I Qualify For Medicare Extra Help

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You automatically qualify for Extra Help if you receive Medicaid coverage, are enrolled in a state-sponsored Medicare Savings Program, or get Supplemental Social Security benefits. You may also be eligible if your:

  • Income is no more than $19,140 per year . Payments that do not count toward your total income include food stamps, housing assistance, disaster assistance, scholarships, and/or education grants.
  • Resources total no more than $14,610 . Resources that count toward your total include savings and checking accounts, stocks, and/or bonds. Items such as your house, car, and/or furniture do not.
  • The cutoff amounts differ if you are caring for dependents or if you live in Alaska or Hawaii.

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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.

    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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    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.

    How Do I Apply For A Low Income Subsidy

    Extra Help Medicare Review 2021

    You can apply for a low include subsidy by following three steps:

  • Find out if you are eligible by using the Extra Help Calculator.
  • Contact the Social Security Administration by phone or fill out the necessary forms online.
  • If you need assistance, get in touch with a licensed insurance agent who can walk you through the process.
  • 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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    What Are The Benefits Of Extra Help

    Extra Help applies to your choice of Medicare Part D plan or Medicare Advantage plan with prescription drug coverage. For qualifying beneficiaries, Extra Help provides:

    • Part D premium subsidies up to 100% of the cost of benchmark Part D premiums in your area.

    • Reduced or eliminated Part D deductibles.

    • Caps on prescription drug copays as low as $1.35 for generics and $4 for brand-name medications.

    In some cases, if you dont qualify for the full benefits, you can still receive partial benefits on a sliding scale according to your income and resources.

    What Does Medicare Part D Cover

    Original Medicare doesnt include coverage for prescription drugs. Instead, Part A covers hospital stays and other inpatient care, while Part B covers medical expenses like emergency care, doctors visits, and equipment.

    A separate Part D plan helps beneficiaries cover the cost of their prescriptions. Part D plans are offered by private insurance companies and have their own premiums, deductibles, and copayments.

    The Part D plan available to you will depend on your state. Its important to compare plans closely. Many plans have a network and work only with certain pharmacies.

    Plus, Part D plans have what is called a formulary. This is a list of drugs covered by the plan. If a prescription you need isnt on a plans formulary, that plan isnt a good fit for you.

    The Medicare website allows you to enter your current pharmacy and medications when you shop for plans, so youll see only plans thatll work for you.

    Other programs that may help you pay for Medicare and healthcare costs

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    Some People Have To Apply For Extra Help

    In some cases, Social Security sends you a notice about Extra Help and the Medicare Savings Program but doesn� ât sign you up automatically. If you get a notice like that, apply for Extra Help â see below to find out how.

    You can also fill out an Extra Help application if youâre just wondering if you might qualify.

    Go through Social Security or a Medicaid office in your state to apply for Extra Help.

    Who Should Not Complete This Application For Extra Help With The Medicare Prescription Drug Plan Costs

    Financial Help Options for Medicare

    You should not complete this online application if:

    • You receive Medicaid and have Medicare, or
    • Your State pays for your Medicare premiums , or
    • You receive Supplemental Security Income payments and have Medicare.

    If you are in one of the 3 groups above, you will automatically get the Extra Help and do not need to apply.

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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 Should I Know About Medicare Extra Help

    Medicare Extra Help is a medication expense assistance program that is managed by the U.S. federal government. Through Extra Help, certain low-income individuals may be eligible for financial assistance in paying for the costs of their medically necessary Medicare Part D prescription drugs.

    If you qualify for Extra Help, you may pay less out-of-pocket for Medicare Part D: Prescription Drug Coverage plan premiums, copays, and yearly deductibles. Of course, how much you will or will not be required to pay is entirely dependent on your income level.

    As of 2021, copays and coinsurance for drug coverage under Extra Help cost no more than $3.70 for each generic drug, and $9.20 for each covered brand-name drug.

    Learn more about who may qualify for Extra Help, and how you can apply for it, right here courtesy of MedicareInsurance.com.

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    Understanding Extra Help Medicare

    The Medicare Extra Help program is designed to provide financial assistance for prescription drugs to people who have Medicare. Its also called the Part D Low-Income Subsidy. This financial assistance is based on your income and level of financial need.

    The federal Medicare Extra Help program covers prescription drugs only. Its different than state-sponsored Medicare Savings programs. Many people who qualify for Medicare Extra Help dont even know it.

    Keep reading to find out if Medicare Extra Help can help with the cost of your prescriptions.

    What Does Extra Help Cover

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    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.

    Medicare costs

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    Extra Help To Pay For Medicare Prescription Drug Costs

    Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help if your yearly income and resources are below these limits in 2022:

    • Single person – yearly income less than $20,388 and less than $14,010 in other resources per year

    You may qualify even if you have a higher income . Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual RetirementAccounts . Resources dont include your home, car, household items, burial plot, up to $1,500 for burial expenses , or life insurance policies.

    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 and will receive 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 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.

    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.

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    Medicare Savings Programs To Help Pay For Medicare Health Care Costs

    You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A and Medicare Part B deductibles, coinsurance, and copayments if you meet certain conditions. There are four kinds of Medicare Savings Programs:

    • Qualified Medicare Beneficiary Program – helps pay for Part A and/or Part B premiums, and in addition Medicare providers aren’t allowed to bill you for services and items Medicare covers like deductibles, coinsurance, and copayments.
    • Specified Low-Income Medicare Beneficiary Program – helps pay for Part B premiums.
    • Qualified Individual Program – helps pay for Part B premiums and funding for this program is limited.
    • Qualified Disabled and Working Individuals Program – helps pay for Part A premiums only.

    If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.

    Who Qualifies For Extra Help

    Medicare Matters: What Counts as Income?

    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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    How Long Will I Receive Extra Help

    After qualifying for the Extra Help program, youll receive its benefits as long as you meet the years income and resource limits. Even if you automatically qualify this year, this may not be the case next year, as changes in your resources and income can affect your ability to receive Extra Help benefits.

    Who Might Need Help With Their Lis

    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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    Who Might Qualify For Extra Help

    As long as you meet certain income and resource limits, you may qualify for Extra Help. As of 2021, you must make less than $19,320 in yearly income and own less than $14,790 in resources in order to qualify.

    The following resources typically count toward your qualification status:

    • Money in a checking or savings account

    The following resources typically do not count toward your qualification status:

    • Up to $1,500 you may have set aside for burial expenses
    • Other household items and personal belongings

    Some people may qualify for Extra Help automatically if they already have Medicare and also receive any of the following:

    • Full Medicaid coverage
    • State Medicaid assistance with paying for Part B premiums
    • Supplemental Security Income benefits

    Even if you dont qualify for Extra Help, you may still be eligible for certain state programs that can help you cover prescription drug costs. Contact your local Medicaid office or your State Health Insurance Assistance Program as soon as possible to learn more.

    Remember, if your income or resources change at any point, you can reapply for Extra Help at any time.

    What Assets Are Included

    Medicare Extra Help Income Limits 2020 Chart

    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 dont 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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    Tips For Applying For Medicare Extra Help

    Applying for a program like Medicare Extra Help might seem like a lot of paperwork. But the application process might be easier than you think. Here are some tips:

    • The form can be filed through the mail or done online by . Make sure to use an original form, and not a photocopy, if youre sending your application through the mail.
    • You dont have to submit documents proving your income or assets, and you dont have to give the government access to your bank account to complete the application.
    • You dont have to list public assistance, foster care payments, interest or dividends from investments on this application.
    • You dont have to list the value of the home you live in, your car, or any farmland property on the application.
    • Listing children or grandchildren who live with you on your application could make you eligible for extra help.

    You can have someone walk you through the process or fill out the form for you by calling 800-MEDICARE

    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.

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