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What Is The Extra Help Program For Medicare

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What Is Medicare Extra Help

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

Prescription drug coverage is important for anyone who is eligible for Medicare. But the cost of this coverage stops many people from getting it.

The Extra Help program can help you pay for your Medicare prescription drug costs. In this article youll learn what Extra Help specifically covers and find out if you qualify for this program.

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.

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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What Are The Income And Resource Limits For Extra Help In 2021

In 2021, the annual income limit for Extra Help for an individual is $19,140. For a married couple who is living together, the limit is $25,860. When your income is calculated, governmental assistance such as food stamps, housing assistance, and home energy assistance arent counted.

Even if your income is higher than the limits, you should still apply for Extra Help if you think you qualify. Some scenarios where youd still be eligible for Extra Help even though your income is over the limit include if you and/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 for Extra Help. Your resources must be equal to or below $14,610 as an individual or $29,160 as a married couple who are living together.

The following examples count as resources:

  • Real estate
  • Money in bank accounts
  • Interest on money slated for use as burial expenses

Contact Social Security for a comprehensive list of excluded resources.

Ial Extra Help Program

Medicare Extra Help &  Low Income Subsidy

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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What Does Extra Help Cover

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

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.

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Interested In More Information

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.

What Is The Medicare Low

Medicare Part D- Extra Help Program

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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How Will I Know If I No Longer Qualify For Extra Help Or If There Are Changes To My Copay Costs

Depending on the exact circumstances, there are a few different ways you will be notified about changes to your Extra Help coverage.

For example, if you got Extra Help at one point, but no longer automatically qualify for next year, you will receive a letter in the mail by the end of September. In this case, you may still qualify for some prescription drug cost assistance, but you will have to apply to find out.

If your copays have changed for next year, you will receive a notice in the mail in early October that will inform you of the new amounts.

If you do not receive a notice from Medicare, you can expect your Extra Help benefits to continue as normal for next year.

What To Know About Medicare Extra Help:

  • The Medicare Extra Help Program, also called the Part D Low-Income Subsidy, helps Medicare beneficiaries with low income and resources pay for the cost of their prescription drugs and prescription drug coverage.
  • To qualify for Extra Help, you must be on Medicare and living in the U.S. with income and financial resources below a certain annual threshold.
  • Many people may qualify for Extra Help without realizing it.
  • You can apply for the Medicare Extra Help Program through the Social Security Administration online, over the phone or in-person, when restrictions allow.

The Medicare Extra Help Program, also called the Part D Low-Income Subsidy, helps Medicare beneficiaries with low income and resources pay for the cost of their prescription drugs and prescription drug coverage. This benefit is worth an estimated $5,000 per year, according to the Social Security Administration.

Many people may qualify for Extra Help without realizing it. To qualify for Extra Help, you must be on Medicare Part A and/or Part B and living in the U.S. with income and financial resources below a certain annual threshold. Here we explain what the Extra Help Program is, who qualifies and how to apply if you do.

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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.

Other Facts About Medicare Savings Program

2017 presentation
  • Healthcare providers wont bill you: You will not be billed for services provided to you in the QMB program Medicaid will pay the medical providers. Ensure that the doctor is aware you are in the QMB program, so they dont bill you incorrectly, and also make sure to Inform Medicare of the charge.
  • You must be qualified: QDWI has disabled, working, and under 65 eligibility requirements. To be eligible for the QDWI program, you must be in Medicare Part As free coverage gap and not be receiving assistance from your state.
  • Re-enroll each year: Medicaid disqualifies you from receiving QI benefits. So, to stay in the QI program, you must reapply each year.
  • Benefits could be delayed before they begin: You must first be accepted by Medicaid before you can start receiving premium assistance. The money that Medicaid paid will be reimbursed to you.

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How Do I Apply For The Extra Help Program

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
  • You’re 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.

    Who Can Get Extra Help

    Some people automatically get Extra Help. If you are on Medicare Part D now and are in one of the following groups, you should already be signed up for the Extra Help program:

    • Dual Eligibles. This means that you get Medicare Part A and/or Part B and you also get some Medical Assistance.
    • On a Medicare Savings Program
    • Getting SSI

    If you are in 1 of these groups and are NOT getting Extra Help, contact the Social Security Administration and apply right away.

    You can also get Extra Help if you are on Medicare Part D now and meet the income eligibility rules.

    You can apply for Extra Help any time. Apply through the Social Security Administration or the State Medicaid office.

    You can apply by phone or have an application mailed to you.

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    What Is The Income Limit For Medicare Extra Help

    Extra Help is a financial support program for those with Medicare. It helps people with limited resources manage the cost of prescribed drugs. An income limit is set which determines eligibility.

    Extra Help is also known as a low income subsidy . This means that the amount of help a person receives from the government may vary as it depends on income and financial need.

    Medicare Extra Help could save an individual a substantial amount of money each year by helping them to pay for premiums, deductibles, and copayments.

    Even though the Extra Help program is beneficial, many individuals who qualify have not yet enrolled.

    This article looks at the Medicare Extra Help program, the income limits, benefits, and how a person can apply to the LIS program to help with the cost of their prescriptions.

    Original Medicare covers the costs of medication during a stay in the hospital, but there is limited coverage for take-home prescription drugs.

    Medicare Part D is a plan that covers prescription drugs. The plan is also known as a prescription drug plan .

    When a person has a PDP, they must usually pay monthly premiums, copayments, and deductibles.

    Private insurance companies administer PDPs, and because of this, different benefits and coverage options may apply. Costs will also vary.

    Each plan has a formulary that specifies which drugs the plan covers.

    An individual should ensure that the plan they wish to enroll in covers the prescription drugs they need.

    Do I Qualify For Medicare Extra Help

    What is Medicare Rx “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:

  • 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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    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.

    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 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.

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