Medicare’s “Extra Help” program is a program that is designed to assist low-income and resource individuals with the cost of Medicare prescription drug coverage (Part D) expenses. The program pays premiums, deductibles, and copayments, thereby making drugs that are necessary to those in need more affordable. In this article, we will learn more about the Extra Help program, its benefits, and how to sign up.
What is Extra Help?
Extra Help is a subsidy program of Medicare Part D that offers monetary assistance to beneficiaries who are qualified. It subsidizes the cost of the monthly premium, yearly deductible, and copays on prescription medication. The program is very important to beneficiaries who cannot afford their drug because of economic issues.
Advantages of Extra Help
- No monthly premium: Beneficiaries pay $0 for their Medicare drug plan premium.
- No annual deductible: No deductible is paid by the beneficiary for drugs covered.
- Lower copayments: The beneficiary pays no more than $4.90 for generic medicines and no more than $12.15 for brand-name medicines in 2025.
- Catastrophic coverage: At a total of $2,000 in drug expense, the beneficiary pays $0 for covered medication.
Eligibility requirements for Extra Help
Beneficiaries must meet some income and resource tests to be eligible for Extra Help. As of 2024, these are:
- Income limit: Income is not more than $22,590 for an individual or $30,660 for a couple.
- Resource limit: Resources are not in excess of $17,220 for an individual or $34,360 for a couple. Resources include cash, savings, stocks, and bonds but not personal items, one automobile, or a home.
Automatic eligibility
Certain individuals are automatically eligible for Extra Help if they are receiving:
- Full Medicaid coverage
- Supplemental Security Income (SSI) benefits
- State assistance paying Medicare Part B premiums
Eligibility and application for Extra Help
If you are not automatically eligible, you can apply for Extra Help through the Social Security Administration (SSA). You can use these application steps:
- Online application: Apply at SSA.gov/extrahelp.
- Phone application: You can call the SSA at 1-800-772-1213 (TTY: 1-800-325-0778).
- In-person application: Make an appointment with your Social Security office.
Once your application is received and processed, the SSA will verify your eligibility and inform you of your qualification or non-qualification.
Extra assistance
If you need extra help or more information on how to apply, you can:
- Call your State Health Insurance Assistance Program (SHIP) for free help.
- Visit Medicare.gov/extrahelp or call 1-800-MEDICARE (1-800-633-4227) for more detailed information on Medicare drug plans and Extra Help.
Medicare Extra Help is an important program for individuals who are just barely managing to keep up with the cost of prescription drugs. By contributing partial help towards the Part D premium, it makes essential medications affordable for individuals living with low income and resources. An understanding of the eligibility and application process can help individuals optimize this helpful program and have access to essential medications.
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