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the medicare drug plan
6 Key Facts

1. Anyone on Medicare can get coverage regardless of income or health.

2. You are not obligated to enroll, but there may be consequences if you don't sign up when you are first eligible to do so.

3. To get Medicare drug coverage, you must select one approved private drug plan among many offering different choices. There is no single government plan.

4. Is your income limited? If you qualify for a part of the program known as "Extra Help." you'll pay very little for your medications.

5. Are your drug costs very high? You'll pay no more than 5 percent of the cost of each prescription after you've spent a certain amount of money out-of-pocket in any one year.

6. Do you have better drug coverage already? You probably won't need Medicare's Part D coverage. But it's wise to check.

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Medicare Prescription Drug Coverage Guide

Part 2: 'Extra Help' Paying for Prescriptions

On limited income, you may qualify for more assistance

En español l "Extra Help" is a special part of Medicare drug coverage that gives much more assistance to people with limited incomes than the regular program does. If you qualify, you can save a lot of money.

If you qualify for “full” Extra Help, you receive coverage throughout the year (no doughnut hole), pay no premium or deductible, pay very little for your prescriptions. If you qualify for “partial” Extra Help, you receive coverage throughout the year and pay a reduced premium and deductible and up to 15 percent of the cost of your drugs.

Will I qualify for Extra Help and what benefits would I get?

Here are the current income limits and benefits under the four levels of Extra Help for 2015 through early 2016:

Level 1: If you receive full Medicaid benefits and live in a nursing home, you automatically qualify for full Extra Help and pay nothing for your prescription drugs.

Level 2: If you receive Medicaid or Supplemental Security Income (SSI) or if your state pays your Medicare premiums, you automatically qualify for full Extra Help. You pay no premium or deductible for Medicare drug coverage. Depending on your income, your copays for each prescription are: $1.20 or $2.65 for generics; $3.60 or $6.60 for brand names and nothing for catastrophic coverage.

Level 3: If your current income is no higher than $1,324 a month (single) or $1,792 a month (for a married couple living together), and your assets (mainly savings) are no more than $8,780 (single) or $13,930 (married), you pay no premium or deductible. Your copays for each prescription are: $2.65 for generic, $6.60 for brand-name drugs and nothing for catastrophic coverage.

Level 4: If your current income is no higher than $1,471 a month (single) or $1,991 a month (for a married couple living together), and your assets (mainly savings) are no more than $13,640 (single) or $27,250 (married), you pay a percentage of your plan’s premium depending on income. You also pay: $66 annual deductible; no more than 15 percent of the cost of each prescription; and, at the catastrophic level of coverage, $2.65 for generics and $6.60 for brand-name drugs or 5 percent of the cost, whichever is greater. (The asset limits above include $1,500 per person for intended funeral expenses, whether or not you’ve set aside money for this purpose.

Note:  You automatically qualify for the catastrophic level of coverage when your total drug costs (what you’ve paid and your plan has paid) reach $4,700 since the beginning of the calendar year.

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