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En español | Yes. The Extra Help program can help people with limited resources and income pay premiums and out-of-pocket costs for Medicare Part D prescription drug coverage.
Medicare doesn’t automatically cover prescription drugs, though you can get a Part D policy from a private insurer that helps with these expenses. But stand-alone Part D policies still have some costs, including monthly premiums that averaged about $33 a month in 2022, deductibles at $480 or less in 2022, and copayments or coinsurance for your medications.
If you qualify, the Extra Help program (also called the Part D Low-Income Subsidy) can reduce these out-of-pocket expenses. Depending on your income, it may eliminate them.
Some qualify automatically. If you receive full Medicaid coverage, get Supplemental Security Income (SSI) or have your Medicare premiums paid through a state program, Medicare will send you a letter confirming that you are eligible for Extra Help and don’t need to apply.
Others can apply. If your assets and income are low enough, you can qualify for full or partial Extra Help. The limits change each year.
• Your assets — savings, investments and real estate, not counting the home you live in — must be worth $30,950 or less in 2022 if you are married and living with your spouse. If you are not married or not living with your spouse, the amount is $15,510 or less.
You don’t need to include these items in your calculations: your home, burial plots, irrevocable burial contracts, life insurance, personal possessions, vehicles, or certain back payments from Social Security or SSI.
• Your income must be less than $27,708 for a married couple living together and $20,628 for an individual. Income includes money you receive from Railroad Retirement, Social Security and Veterans Affairs benefits; net earnings from self-employment; other pensions; rental income; wages; and some other kinds of income.
You can apply for Extra Help through the Social Security Administration, which also handles Medicare enrollment. You fill in the forms on the SSA website, call Social Security (800-772-1213) or schedule an appointment at your local Social Security office.
The program has different levels of help, depending on the amount of your income and assets and whether you qualify for Medicaid or a Medicare Savings Program; the latter program can help Medicare beneficiaries who have few resources pay premiums and out-of-pocket costs for both parts A and B of Medicare.
Medicare will send you a notice letting you know what level of Extra Help you qualify for.
If you receive Medicaid benefits or are eligible for a Medicare Savings Program, you qualify automatically for Extra Help. Eligibility varies by state.
• You will pay no premium or deductible for Medicare Part D drug coverage.
• Your copayments will be no more than $3.95 for generics and $9.85 for brand-name drugs. If you receive Medicaid and your income is lower ($18,552 as a married person living with your spouse or $13,836 if single), the copayments are further reduced, to $1.35 for generics and $4 for brand-name drugs.
• You’ll have no copays for your medications after you’ve paid $7,050 in out-of-pocket drug costs for 2022, the Part D catastrophic level.
You can qualify for full Extra Help benefits without being part of Medicaid or a Medicare Savings Program if you’re married and have income of less than $24,960 and assets under $15,600, or single with income of less than $18,588 and assets below $9,900.
• You’ll pay no premium or deductible for Part D.
• Your copayments will be no more than $3.95 for generics and $9.85 for brand-name drugs.
• You’ll have no copays for your medications after you’ve paid $7,050 in out-of-pocket drug costs for 2022.
You may qualify for partial Extra Help if your income is slightly higher (up to $27,708 in income and $30,950 in assets if married, and up to $20,628 in income and $15,510 in assets if single).
• Your premiums will vary based on income.
• Your deductible will be no more than $99.
• Your coinsurance — your share of the cost of your medications — will be no more than 15 percent of the price. When you reach that Part D catastrophic level, you will pay no more than $3.95 for generics and $9.85 for brand-name drugs or 5 percent of the drug’s cost (whichever is less).
You still have more to do. Qualifying for Extra Help, even automatically, is only one step of the process. You still must enroll in a Part D plan to get your prescriptions covered.
If you don’t choose a plan, the Centers for Medicare & Medicaid Services (CMS) will choose one for you.
CMS will send you a letter to let you know what plan you have been enrolled in and how to change plans if the one selected for you doesn’t cover your drugs or your preferred pharmacy. You can use the Medicare Plan Finder to compare coverage for plans in your area.
No time limits. You can apply for Extra Help anytime. If you qualify, you can switch Part D plans as often as once each calendar quarter during the first three quarters of the year.
You can also change plans during open enrollment, from Oct. 15 to Dec. 7. Part D plans can change their costs and coverage each year, so it’s a good idea to compare your options at least annually.
More people will qualify in 2024. Income limits to qualify for full Extra Help will increase in 2024, thanks to the Inflation Reduction Act, signed into law on Aug. 16, 2022. Those who meet present income caps for partial Extra Help will receive full benefits.
Need more help? Your State Health Insurance Assistance Program can assist you in applying for Extra Help or choosing a Part D plan.
Updated August 16, 2022
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