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.
The Parts Of Medicare
Social Security enrolls you in Original Medicare .
- Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
- Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.
- Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
- Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
- Medicare Part D helps cover the cost of prescription drugs.
Most people age 65 or older are eligible for free Medical hospital insurance if they have worked and paid Medicare taxes long enough. You can enroll in Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .
Is There Also Extra Help For Medicare Part B
While Extra Help only helps you with your prescription drugs, there are other Medicare Savings Programs which are run by the State and may help qualified persons with their Medicare Part B costs for medical insurance. If you qualify for Extra Help, you may also submit your application for the Medicare Savings program in your state. Each state has different regulations about the eligibility. You can get more information at your states Medicaid office or your State Health Insurance Assistance Program .
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Do I Qualify For Medicare Extra Help
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:
The cutoff amounts differ if you are caring for dependents or if you live in Alaska or Hawaii.
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What Is The Medicare Extra Help Program
At Commonwealth Care Alliance® , we believe that our members should have access to the care they need. But we know healthcare can be expensiveespecially for those on a fixed income. Thats why we want you to know that you may qualify for Extra Help to help pay for your prescription costs and lower your monthly plan payment.
What is Extra Help?
Extra Help is a government program for people who have a limited income. If you qualify for Extra Help, you could pay a lower copayment for your prescription drugs. Based on your income, you could save up to $5,000 a year on your prescriptions.1
How do you qualify for Extra Help?
To start, answer these 2 questions.
If you answered YES to any of these questions, you may qualify for Extra Help.
When can you enroll for coverage if you qualify for Extra Help?
If you qualify for Extra Help, your status will trigger a Special Enrollment Period and you can enroll or switch to a CCA Medicare plan during either:
- The first nine months of the year, once per calendar quarter, during a Special Enrollment Period
- From October 15th through December 7th during the Medicare Open Enrollment Period
Once we know you qualify for Extra Help, see how much less you could pay
Find out if you qualify for Extra Help:
Want to learn more about CCA Medicare plans?
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When Can I Apply For Medicare Part D
There are two main enrollment periods for Part D coverage: Medicare Initial Enrollment PeriodThe Initial Enrollment Period is the seven-month period around your 65th birthday when most people are eligible for the first time to enroll in Medicare. and Open Enrollment.The Medicare Open Enrollment Period , also known as the Annual Enrollment Period, runs from October 15 to December 7 each year and allows you to make multiple Medicare-related changes. In addition, Affordable Care Act Open Enrollment allows changes to non-Medicare coverage from November 1 to December 15. You can also enroll during the Special Enrollment PeriodA Special Enrollment Period is an opportunity outside of a standard enrollment period in which your specific circumstances allow you an opportunity to make changes to your Medicare-related coverage. if you qualify. Lets take a look at the specific dates for when you can enroll.
How To Qualify For Medicare Extra Help
Sounds great, right? It is, but not everyone is eligible for Extra Help. To qualify, Medicare beneficiaries must:
- Reside in the United States and be enrolled in or eligible for a Part D prescription drug plan.
- Meet the resource limits. For 2022, the Extra Help resource limits are $15,510 for an individual or $30,950 for a married couple living together. Resources means bank accounts, real estate other than the primary residence, stocks, bonds, mutual funds, IRAs, and cash. This does not include primary residences, vehicles, personal possessions, life insurance policies, and burial expenses.
- Meet the income limit for Medicare Extra Help.The Medicare Extra Help income limits for 2022 are annual incomes below $19,320 for individuals or $26,130 combined for married couples. In this case, income does not include food stamps, housing assistance, home energy assistance, medical treatment and drugs, disaster assistance, tax credit payments, assistance from others, victims compensation payments, scholarships, and education grants. Beneficiaries who earn more can still qualify if they:
- Support other family members who live with them
- Have other earnings from work
- Live in Alaska or Hawaii
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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.
How To Apply For Medicare Part D Extra Help Program
Applying for this program is not difficult. You can visit Medicare.gov to get started with an online application for the Extra Help program. The easiest and fastest way to apply is by completing the online application. You should remember, however, that applying for Extra Help does not enroll you in Medicare prescription drug coverage. You will need to enroll in a drug plan separately through the health care insurance provider of your choice. You may even choose to enroll in a Medicare Advantage plan that includes drug coverage.
If you cannot complete your application online, there are other ways that you can apply for this helpful program. You may call the Social Security Administration toll-free at 1-800-772-1213 to complete an application for the Extra Help program. You can call 1-800-Medicare to learn more about your options for prescription drug coverage. Lastly, you can make an appointment at your local Social Security office to complete a paper application in person. Remember that these offices do not accept walk-ins currently, so you will need to call and schedule an appointment first.
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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.
Documentation Required For Extra Help
When completing your Extra Help application, there is certain documentation that you will need to present that proves your eligibility for the program. You will need your Social Security card and number to prove your identity when applying for the program. Next, you will need documents that prove your income and assets. Some of these include tax returns, bank statements, payroll slips, Social Security benefit letters, and other items that show how much money you make each month.
You might also be required to present statements from a savings account or retirement accounts like a 401k or IRA. If you receive veterans benefits or benefits from the Railroad Retirement Board, then be prepared to show those as well. There is no specific list of documents that will be required, but you should be prepared to show any documents necessary to prove your income level and assets. If you do not truly need assistance with Medicare prescription drug costs, you will likely not be approved for the program.
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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.
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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.
Medicare Extra Help Income Limits 2022
To qualify for Extra Help, your resources must be limited to $19,320 for an individual or $26,130 if you and your spouse live together.
Note that resources doesnt mean income! Resources are your combined savings, investments and real estate. Your primary home, your vehicles, any personal possessions, your life insurance and some other financial sources however do NOT count.
You may still qualify for Extra Help even if your resources are higher than the limit, e.g. if you live in Hawaii or Alaska or support family members living with you.
Only people living in one of the 50 states or D.C. can get Extra Help. The best way to find out if you qualify is to visit the SSA.gov website.
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What Are The Benefits Of Extra Help
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.
The Part D Standard Benefit
At a minimum, plan sponsors must offer a standard benefit package mandated by law. The standard benefit includes an annual deductible and a gap in coverage, previously referred to as the Donut Hole. Sponsors may also offer plans that differ from but are actuarially equivalent to the standard benefit. Finally, they may also offer enhanced plans that provide benefits in addition to the standard benefit. Typically, the enhanced plans offer some coverage during the Donut Hole.
The Standard Benefit is defined in terms of the financial structure of the cost-sharing, not the drugs that must be covered under the plan.
Medicare does not establish premium amounts for plans. Instead, premiums are established through an annual competitive bidding process and evaluated by CMS. Premiums vary from plan to plan and from region to region. Medicare does establish the maximum deductible amount, the Initial Coverage Limit, the TrOOP threshold, and Catastrophic Coverage levels every year. The table below shows the standard benefit for this year .
Standard Part D Benefit 2020-2021
Alternatives to the Standard Benefit
Income-Related Monthly Adjustment Amount Part D
Income-Related Adjustments 2021
Who Automatically Receives Extra Help
You are automatically eligible for Extra Help if you have Medicare Part A or Part B and at least one of the following applies:
You are entitled to Supplemental Security Income, or SSI.
You are eligible for full Medicaid coverage.
You are enrolled in a Medicare Savings Program as a Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary or Qualified Individual.
If you automatically qualify, you dont need to apply to receive the benefits.
If you dont automatically qualify, you should still apply for Extra Help if you might meet the income and resource criteria.
How To Pay For Part D
After youve signed up, youll pay monthly Part D premiums to the insurance company. You may either receive bills or sign up for automatic payments. You also may be able to request that your premium be deducted from your monthly Social Security or Railroad Retirement Board payment.
Medicare beneficiaries with low incomes and few assets may qualify for the federal Extra Help program that givesfinancial assistance to pay for Part D premiums, deductibles and copayments.
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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
How Does Medicare Extra Help Reduce Drug Costs
People who have Medicare Extra Help find that the amount by which it reduces prescription drug costs may vary.
The SSA estimate that Medicare Extra Help reduces prescription drug costs by about $5,000 a year for each recipient.
Medicare Extra Help reduces drug costs in several ways. It lowers the monthly premium for Medicare Part D. People that receive full Extra Help pay a $0 premium and do not have to meet a deductible.
In 2020, they also have a $3.60 copayment for generic drugs and an $8.95 copayment for brand-name drugs. After they reach $6,350, they no longer need to provide a copayment when buying medications.
Medicare Part D includes prescription medication copayments. As these may vary, the Part D copayment may be lower than the Medicare Extra Help copayment. Individuals with Extra Help pay whichever copay is lower.
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