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Can I get help to pay for my prescription drugs if my income is low?

En español | Extra Help is a program that has saved huge amounts of money for Medicare beneficiaries with limited incomes and, in many cases, has allowed them to take needed medications that they wouldn’t otherwise have been able to afford. Here’s a list of the main points you need to know about the program and how it works:

  • You automatically qualify for Extra Help if you receive Medicaid or Social Security Income (SSI — a federal financial assistance program run by Social Security), or if your state pays your Medicare premiums. In this situation, Medicare will send you a letter (in a purple envelope) confirming that you’re eligible for Extra Help and don’t need to apply.
  • If you don’t qualify automatically, you must apply to Social Security. Call its customer service line at 800-772-1213 or apply online at https://www.ssa.gov/medicare/prescriptionhelp/
  • Eligibility depends on your income and what they call “assets” or “resources” (which mainly means your savings). You can see the current income and asset limits — together with the different levels of Extra Help you may qualify for — in a chart provided by the Medicare Rights Center at http://www.medicarerights.org/fliers/Help-With-Drug-Costs/Extra-Help-Chart.pdf?nrd=1.
  • If you don’t qualify for full Extra Help, you may still qualify for partial Extra Help, which provides drug coverage at lower cost than in the regular Part D program.
  • If you qualify for full or partial Extra Help, you get full drug coverage throughout the year. There is no doughnut hole in the Extra Help program. 
  • If you receive Extra Help, you can switch to a different Part D drug plan at any time of the year — no waiting for the annual open enrollment period.
  • Qualifying for Extra Help, even automatically, is only one step in the process. You still have to enroll in a Part D drug plan to get your prescriptions covered. 
  • If you need help in applying for Extra Help or choosing a Part D drug plan, contact your state health insurance assistance program (SHIP). There is no charge for this service. For contact information, go to www.shiptacenter.org and select your state. 

For detailed information on the Extra Help program, see section 2 of AARP’s consumer guide to the Part D program, at http://www.aarp.org/health/medicare-insurance/info-11-2009/part_2_extra_help_paying_for_drugs.html

     

        


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