Part 2: 'Extra Help' Paying for Prescriptions

On limited income, you may qualify for more assistance

by: Patricia Barry | from: AARP Bulletin | Updated November 2010

Medicare Part D Guide

— Tetra Images/Corbis

   1. How Part D Coverage Works
   2. Extra Help Paying for Drugs
   3. The Doughnut Hole
   4. Do You Need Part D?
   5. Choosing a Part D Drug Plan
   6. Enrolling in Medicare Part D
   7. Glossary of Terms
   8. Where To Go For Help
   9. Use the Medicare Plan Finder

Medicare Part D (main page) Go

"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) and 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 of the four levels of benefits under Extra Help:

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:

In 2010 and 2011: $1.10 or $2.50 for generics, $3.30 or $6.30 for brand-name drugs and nothing for catastrophic coverage.

Level 3: If your current income is no higher than $1,218.38 a month (single) or $1,639.13 a month (for a married couple living together), and your assets (mainly savings) are no more than $8, 100 (single) or $12,910 (married), you pay no premium or deductible. Your copays for each prescription are:

In 2010 and 2011: $2.50 for generics, $6.30 for brand-name drugs and nothing for catastrophic coverage.

Level 4: If your current income is no higher than $1,353.75 a month (single) or $1,821.25 a month (for a married couple living together), and your assets (mainly savings) are no more than $12,510 (single) or $25,010 (couple), you pay a percentage of your plan’s premium depending on income. You also pay:

In 2010 and 2011: $63 annual deductible; no more than 15 percent of the cost of each prescription; and, at the catastrophic level of coverage, $2.50 for generics or $6.30 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.)