Extra Help for Medicare Part D is a program to help people with limited income and resources pay Medicare prescription drug costs. For example, Extra Help can help pay your Medicare Part D premiums, deductibles, and copayment costs. To join a Medicare Part D drug plan, you must have Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). However, you must have both Part A and Part B to join a Medicare Advantage plan. Now that you know Extra Help pays for your prescription drug costs, how do you qualify?
According to SSA.gov, to qualify for Part D Extra Help, you must be receiving Medicare and have limited resources and income. Furthermore, you must reside in one of the 50 States or the District of Columbia. As MedicareBob shows in his video, Extra Help is not available in Puerto Rico, U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. Next, discover if you automatically qualify for Extra Help.
You automatically qualify for Extra Help if you have any one of the following:
If you meet any of the above conditions, Medicare will send you a PURPLE notice. We advise you to keep this “Deemed Status Notice.” You do not need to apply for Extra Help. Then provide your Medicare Part D plan this document. It proves you qualify for Extra Help.
Furthermore, you can provide Medicare Part D with the following documents as proof that you qualify for Extra Help:
As of February 2021, SSA.org published Understanding the Extra Help With Your Medicare Prescription Drug Plan. It states your resources and income must be limited to $14,790 for an individual or $29,520 for a married couple living together. Resources include things of value that you own, which may include the following:
On the other hand, resources that do not count include the following:
The amount of Extra Help you receive depends on your income and resources. You can receive either a full-subsidy or a partial subsidy. Anyone who meets State Medicaid financial eligibility qualifies for Full Low-Income (LIS) Subsidy and pays no premiums, no deductible, no copay, and no coinsurance. Furthermore, anyone who qualifies for Full LIS will pay no more than $8.95 copay for brand-name and $3.60 copay for generic drugs.
In addition to lower out-of-pocket expenses, Medicare beneficiaries with Extra Help have three Special Enrollment Periods. You can join or switch Medicare Part D drug plans every three months from January through September. Furthermore, you can join or switch during the Annual Enrollment Period (Oct 15 – Dec 7). Moreover, you do not pay Part D late enrollment penalties.
You can apply for Extra Help online. To complete the application, you will need to provide SSA.gov information about your income and resources. Documents that can help you include the following:
Apply for Extra Help at Social Security Administration website.