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 2017:
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 coverage – no premiums, deductibles or copays.
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 in 2016 are: $1.20 or $3.60 for generics; $3.60 or $7.40 for brand names and nothing for catastrophic coverage. In 2017, copays are $1.20 or $3.70 for generics; $3.70 or $8.25 for brand names and nothing for catastrophic coverage.