You may already know that Medicare offers prescription-drug coverage through its provision called "Part D." But did you know that Medicare also offers Extra Help paying for your prescription drug costs if you have limited income and limited resources?
Extra Help can reduce or eliminate premiums, deductibles, and copayments, and can provide you with coverage all year long—with no doughnut hole. You could save a lot of money, possibly even thousands of dollars.
Who Should Apply for Extra Help?
You may qualify if you currently have Medicare and:
- Your annual income is less than $16,245 ($1,354 per month) for a single person or less than $21,855 ($1,821 per month) for a married couple living together, and
- You have resources and assets (savings accounts and investments) that are less than $12,510 for a single person or $25,010 or less for a married couple living together.
- Income and asset limits may increase each year.
- Assets such as the house you live in, your vehicle and your personal possessions do not count.
If you get Medicaid Supplement Security Income (SSI) or your state pays your Medicare premiums, you automatically qualify for Extra Help. You do not need to apply.
Additionally, if you…
a) Live in Alaska or Hawaii,
b) Provide more than half the financial support for a person living with you, or
c) Have earned income, such as wages
…you may have a higher income and still qualify for Extra Help.
When Should You Apply?
You can apply anytime. But the sooner you do, the sooner you will find out whether or not you are eligible for Extra Help. If you qualify, you still need to choose and sign up for a plan through Medicare Part D, but you will not have to pay a late-enrollment penalty.
How to Apply for Extra Help
Do you have a computer? If so, it is easy to apply online, and you have two options to do so:
If you prefer to apply over the phone or by mail, call, toll-free, 800-772-1213. You can also request a paper application when you call. Send your completed paper application to the following address:
Social Security Administration
Wilkes-Barre Data Operations Center
P.O. Box 1020
Wilkes-Barr, PA 18767-9910
Please note that paper applications are processed by computer, so using pencil or black pen speeds your answer.
To apply in person, check the blue pages of your phone book for the Social Security Office nearest you.
Enrolling in a Medicare Part D Drug Plan
- If you qualify for Extra Help, the next step is to choose and enroll in a Medicare Part D drug plan. You must enroll in a Part D drug plan approved by Medicare to receive savings on your prescription costs. The best way to choose a plan is to compare how or whether it covers the medicines you take and whether or not your pharmacy accepts the plan. If you do not choose a plan, Medicare will select one for you.
- Medicare has a drug-plan finder. Using the finder will help you choose which plan meets your needs. You can also get this information by calling the Medicare help line, toll-free, 877-633-4227.
- For help choosing a plan, contact your State Health Insurance Assistance Program (SHIP).
- If the Social Security Administration tells you that you don’t qualify for Extra Help, you have 60 days to appeal the decision. You can file an appeal at one of its local offices or by mail, phone, or fax.
- Even without Extra Help, you will likely save money on prescription drugs by joining a Medicare drug plan. You can enroll when you first become eligible for Medicare or between November 15 and December 31 each year.
Other Helpful Information
- Use AARP’s Benefits QuickLink to find other drug benefits and separate programs that may cut the cost of utilities or property taxes.
- AARP has a wealth of information, useful tools, and resources for those who are helping care for loved ones as they age.
- You can contact the Social Security Administration (SSA) online, toll-free at 800-772-1213, or TTY, 800-325-0778.
- You can contact the Centers for Medicare and Medicaid Services online, toll-free at 800-633-4227, or TTY, 877-486-2048.
- SHIP provides free, unbiased insurance counseling and help with other benefits available to you. Contact SHIP to find a state program near you.
- An Area Agency on Aging is a local organization that connects older people and their caregivers to services and programs. Find your local AAA by calling, toll-free, 800-677-1116, or by visiting the Elder Care Locator.
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