Medicare Extra Help Eligibility
Your eligibility for this program depends on your savings, investments, real estate , income, and your spouse. According to Social Security, your resources must be under $14,610 for an individual or $29,160 for a married couple living together to qualify.
Your resources include a variety of personal assets, including:
- Mutual funds between you and your spouse
- Individual Retirement Accounts
- Any cash in your home or elsewhere
There are resources, however, that do not contribute to this amount, including:
- Your primary residence
- Resources you couldnt easily convert to cash
- Property you need for self-support
- Non-business property essential to your self-support
- Life insurance policies
- Burial expenses
- Interest earned on money you plan to use for burial expenses
Your eligibility to this program also depends on your yearly incomethe limit is $19,140 for an individual or $25,860 for a married couple living together . These resources do not count towards your income:
- Supplemental Nutrition Assistance Program
- Housing assistance
- Earned income tax credit payments
- Assistance from others to pay your household expenses
- Victims compensation payments
- Scholarships and education grants
See If You Qualify For Extra Help
Some people automatically qualify for the Extra Help program and don’t need to apply. Medicare will mail you a letter if you automatically qualify for Extra Help.Your income and resources can change from year to year, so check to see if you qualify for the program if you didnt receive a letter from Medicare or were previously denied for the Extra Help program.
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.
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How Can You Get The Extra Help
To get Extra Help with Medicare prescription drug costs, you must complete and submit this application. The Social Security Administration will review your application and send you a letter to let you know if you qualify for Extra Help. SSA will also send you information about the Medicare Prescription Drug Coverage and tell you what you should do next.
NOTE: To apply, you must live in one of the 50 States or the District of Columbia.
What Are The Income Limits For Extra Help With Medicare In 2021
For 2022, our resource limits must be below $27,950 for a couple, and $14,010 if you are not married or living alone. Your primary residence, vehicles, personal property, life insurance, and burial plots are not included in this total.
Government assistance such as food stamps, housing assistance, and utility help is not counted in the income.
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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.
If You Qualify For Extra Will You Still Pay A Late Enrollment Penalty
If you qualify for Extra Help, you may also be eligible for a Special Enrollment Period. This means that you can enroll in a Medicare prescription drug plan even if its outside of the annual Open Enrollment Period. You will not have to pay a late enrollment penalty as long as you enroll within 60 days of qualifying for Extra Help.
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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 Qualifies For Extra Help With Part D Premiums
Some qualify automatically. If you receive full Medicaid coverage, get Supplemental Security Income or have your Medicare premiums paid through a state program, Medicare will send you a letter confirming that you are eligible for Extra Help and dont need to apply.
Others can apply. If your assets and income are low enough, you can qualify for full or partial Extra Help. The limits change each year.
Your assets savings, investments and real estate, not counting the home you live in must be worth $30,950 or less in 2022 if you are married and living with your spouse. If you are not married or not living with your spouse, the amount is $15,510 or less.
You dont need to include these items in your calculations: your home, burial plots, irrevocable burial contracts, life insurance, personal possessions, vehicles, or certain back payments from Social Security or SSI.
Your income must be less than $27,708 for a married couple living together and $20,628 for an individual. Income includes money you receive from Railroad Retirement, Social Security and Veterans Affairs benefits net earnings from self-employment other pensions rental income wages and some other kinds of income.
You can apply for Extra Help through the Social Security Administration, which also handles Medicare enrollment. You fill in the forms on the SSA website, call Social Security or schedule an appointment at your local Social Security office.
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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.
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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.
The following examples count as resources:
- Money in bank accounts
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How Medicare Extra Help Works
Once you have a plan, youll have to provide the insurer with documentation to prove that you are receiving Extra Help. The documents that count as proof include
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A purple, yellow, or green notice of automatic qualification from Medicare
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An Extra Help award notice from the SSA
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Your Supplemental Security Income award letter
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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. Youll 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.
Senior Editor & Personal Finance Expert
Derek is a former senior editor and personal finance expert at Policygenius, where he specialized in financial data, taxes, estate planning, and investing. Previously, he was a staff writer at SmartAsset.
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How Does The Extra Help Program Work
The Extra Help Program covers roughly $5,000 of the out-of-pocket costs of Part D per year, including monthly premiums, annual deductibles, and prescription co-payments. This program will:
- Pay for your Part D premium
- Lower the cost of your prescription drugs
- Give you a Special Enrollment Period once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans
- Eliminate Part D late enrollment penalties you may have
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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How Much Medicare Extra Help Can Save You
Even if you qualify for Medicare Extra Help, your income level, resource level, marital status, and Medicaid eligibility will determine whether you qualify for full or partial Extra Help.
Medicare Extra Help can be understood in relation to Medicare Part D. If you qualify for Extra Help, then it reduces your Part D out-of-pocket costs. In certain circumstances, you’ll pay $0 in Part D premiums and deductibles and heavily reduced copays for prescriptions. The table below explains how Extra Help reduces Part D costs.
If you qualify for both Medicaid and Medicare Extra Help, and are receiving care in an institution, such as an assisted living facility, nursing home, or rehabilitation hospital, or from certain home and community health services, then Extra Help may reduce your Part D costs to nothing.
What Does Medicare Extra Help Cover
Extra Help applies to Medicare Part D expenses only. It will not pay for Part A or Part B premiums, deductibles, or copays. Extra Help is estimated to be worth $5,100 per year, according to the Social Security Administration however, the level of Extra Help a beneficiary receives depends primarily on their annual income, and will fully or partially cover various Part D expenses, including the following:
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Finding Help With Prescriptions Guide
“Finding Help with Prescriptions” Guide is a free publication. It provides helpful information for lowering your prescription costs including low-income assistance, patient assistance programs, mail order prescription services, veterans pharmacy benefits, and Community Health Centers.
To request a copy, call SHIP free of charge 452-4800 or email
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How To Apply To The Medicare Extra Help Program
To apply for the Extra Help program, you may contact or visit the Social Security office. If you apply and need to provide additional documentation to receive more cost coverage, you may be able to send your plan:
- A purple notice from Medicare that says you automatically qualify for Extra Help.
- A yellow or green automatic enrollment notice from Medicare.
- An Extra Help Notice of Award from Social Security.
- An orange notice from Medicare that says your copayment amount will change next year.
- Your award letter from Social Security as confirmation that you have SSI .
- 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.
- 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 that shows you have Medicaid.
- A screen print from your states Medicaid systems that shows you have Medicaid.
- Any other document from your state that shows you have Medicaid.
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Medicare Part D Costs After Medicare Extra Help By Marital Status
Medicare Extra Help for single people
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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
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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
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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.
Who Qualifies For Medicare Extra Help How To Apply
Most Medicare beneficiaries receive coverage for hospital visits through Medicare Part A and typical medical services through Medicare Part B. They may also opt into Medicare Part D, an optional portion of Medicare specifically for prescription drug coverage. But medications arent cheap, and neither are insurance premiums and deductibles, so individuals with limited income can apply for financial assistance through the Medicare Extra Help program.
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Medicare Extra Help Benefits
The primary benefit of Medicare Extra Help is to make your Medicare Part D plan more affordable. There are a lot of Medicare beneficiaries who struggle to make ends meet due to being on a fixed income or losing a spouse who was a source of income.
With Medicare Extra Help, you can receive partial or full assistance paying for your Medicare Part D monthly premium and deductible, along with adjustments to your copayment for specific drugs. Its a major benefit, especially for those who need a lot of prescription medication.
Medicare Part D Extra Help
Medicare Part D Low Income Subsidy , which is also known as Extra Help, helps pay for Medicare Part D monthly premiums, deductibles, copays and coinsurance.
You can apply for Extra Help online on the Social Security website you can get help apply by calling the Senior LinkAge Line at 800-333-2433, Monday Friday between 8:00 a.m. – 4:30 p.m.
The Senior LinkAge Line is Minnesotas federally designated State Health InsuranceAssistance Program and provides free help with all issues related to Medicare.
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Who Should Not Complete This Application For Extra Help With The Medicare Prescription Drug Plan Costs
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.
What Is The Medicare Extra Help Program
At CCA, 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 about $5,100 a year on your prescriptions.1
How do you qualify for Extra Help?
To start, answer these 3 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
Find out if you qualify for Extra Help:
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