Are you struggling to pay for your Medicare prescription drugs? A lot of people would qualify for extra help if they would simply apply for assistance. Unfortunately, most people don’t know that the Extra Help program even exists!
[This post was updated on April 1, 2018.]
What is Extra Help?
Extra Help, also referred to as a Low-Income Subsidy (LIS), is a federal program that lowers Medicare Part D Prescription Drug Plan monthly premiums, annual deductible, copayments, and coinsurance for those who have limited resources and income, and reside in one of the 50 States or the District of Columbia. The Extra Help is estimated to be worth $4,000 per year.
Depending on your level of eligibility, Extra Help may:
- Pay for some (or all) of your monthly premiums
- Pay for some (or all) of your other Medicare Part D related drug costs, including your annual deductible, copayments, and coinsurance
- Protect you from a late enrollment penalty
- Protect you from going into your Medicare Part D Prescription Drug Plan’s “donut hole” coverage gap. (Not all plans have one.) This is especially important for those who are on Tier 3 and Tier 4 prescription drugs.
Once you are enrolled in a Medicare Prescription Drug Plan (PDP) or a Medicare Advantage Prescription Drug Plan (MA-PD), the Extra Help subsidy is applied to your coverage. Your coverage begins the first day of the month after you qualify for Extra Help and ask to join a plan.
In 2018, those who qualify for full Extra Help benefits pay no more than $3.35 for generic covered drugs (or brand-name drug treated as a generic) and $8.35 for brand-name covered drugs.
What does it take to qualify for Extra Help?
In 2018, to qualify for Extra Help you must have:
- Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance)
- You must be enrolled in (or will be enrolled in) a Medicare Part D plan; either a stand-alone Part D plan or one that is part of a Medicare Advantage plan
- A U.S. Citizen or legal resident (includes the 50 states or the District of Columbia)
- Your resources are limited to $14,100 for an individual or $28,150 for a married couple living together.
- Your annual income is limited to $18,210/year ($1517.50/mo) for an individual, and $24,690 ($2,057.50/mo) for a married couple living together. In some cases, you may have a higher income and still qualify for Extra Help, such as if you or your spouse:
- Support other family members who live with you
- Have earnings from work; or
- Live in Alaska or Hawaii
Some people qualify automatically
A PURPLE notice from the Centers for Medicare and Medicaid Services (CMS) means that you automatically qualify for Extra Help and there is no need to apply, because of any of the following:
• You have both Medicare and Medicaid
• You’re in a Medicare Savings Program
• You get Supplemental Security Income (SSI) benefits
A YELLOW or GREEN notice from CMS means you automatically qualify for Extra Help and there is no need to apply, because you qualify for Medicare and Medicaid and currently get benefits through Original Medicare. You’ll be automatically enrolled in a Medicare Prescription Drug Plan unless you decline coverage or join a plan yourself.
An ORANGE notice from CMS means that you still automatically qualify for Extra Help and there’s no need to apply, but your copayment levels are changing next year.
A GREY notice from CMS means that you no longer automatically qualify for Extra Help for one of these reasons:
• You no longer qualify for Medicaid
• You no longer belong to a Medicare Savings Program (help from your state Medicaid Program to pay your Medicare Part B premiums).
• You no longer get Supplemental Security Income (SSI).
What if I don’t qualify for Extra Help?
There are other financial aid programs that may be able to assist you. For example, Nevada’s State Pharmacy Assistance Program (SPAP) is called Senior RX. For those who qualify, this program provides relief from the high costs of prescription drugs when you are in the “donut hole” (coverage gap). Effective July 1, 2017, to qualify, the maximum annual household income for singles is $28,709, and the maximum annual household income for married couples is $38,270. This includes income from all sources for both applicant and spouse. Proof of income, such as a copy of your 2017 tax return or 12-months of your most recent bank statements, is required when submitting a new application. You must have lived continuously in Nevada for at least 12 consecutive months prior to the date of application.
Click HERE to learn more about Extra Help and other financial assistance programs.
You can also contact us if you would like to us to assist you with applying for Extra Help.
SPECIAL ENROLLMENT PERIOD (SEP)
Those who are approved to receive Extra Help (and other low income subsidies) qualify for a Special Enrollment Period (SEP). This will allow you to change your current Medicare Advantage and/or Medicare prescription drug plan to one that meets or exceeds your current plan’s coverage.
If you have questions about Medicare or other life & health insurance products, click here to contact Linda Bell, a licensed independent insurance broker at Heart to Heart Insurance Agency, LLC.
Disclaimer: Heart to Heart Insurance Agency LLC is not connected with or endorsed by the United States Federal Government, Centers for Medicaid and Medicare Services, or the Department of Health and Human Services.