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

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 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. Part D policies still have some costs, however, including premiums that average $55.50 a month in 2024, a deductible of $545 or less, and copayments or coinsurance for your medications.

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If you qualify, the Extra Help program, also called the Part D low-income subsidy, can reduce these out-of-pocket expenses. And depending on your income, it may eliminate them altogether. In 2024, more folks are qualifying for Extra Help benefits thanks to the Inflation Reduction Act.

The Social Security Administration, which runs the Extra Help program with the Centers for Medicare & Medicaid Services, estimates that the program can reduce prescription drug expenses for low-income beneficiaries by an estimated $5,300 a year.

Who qualifies for Extra Help with Part D premiums?

Some qualify automatically. If you receive full Medicaid coverage, get Supplemental Security Income (SSI) or have your Medicare premiums paid through a state Medicare Savings Program, Medicare will send you a letter confirming your Extra Help eligibility, meaning you won’t have to apply.

Others can apply. If your assets and income are low enough, you can qualify for Extra Help. The limits change each year.

Your assets — savings, investments and real estate, not counting the home you live in — must be worth $17,220 or less for individuals in 2024, or $34,360 or less for married couples living together. Those limits include an allowance of up to $1,500 per person for burial expenses.

You don’t need to include these items in calculating your assets: your primary residence, personal possessions, vehicles and life insurance policies. For more information, see the Social Security Administration’s “Understanding the Extra Help With Your Medicare Prescription Drug Plan."

Your income in 2024 must be less than $22,590 for an individual or $30,660 for married couples living together. The income limits, which change annually, are based on the federal poverty level and are higher for Alaska and Hawaii.

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 other income. You can find a complete list in the Understanding Extra Help guide.

You can apply for Extra Help through the Social Security Administration, which also handles Medicare enrollment. Complete the forms on the SSA website, call Social Security (800-772-1213) or schedule an appointment at your local Social Security office.

What does Extra Help cover?

The program has different levels of help, depending on your income and assets and whether you qualify for Medicaid or a Medicare Savings Program, which helps Medicare beneficiaries with few resources pay premiums and out-of-pocket costs for Medicare Parts A and B.

Medicare will send you a notice letting you know which 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 $4.50 for generic drugs and $11.20 for brand-name drugs in 2024. If you receive Medicaid and your income is lower, below $15,060 for individuals or $20,440 for married couples living together in 2024, your copayment will be no more than $1.55 for generics and $4.60 for brand-name drugs.

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You can qualify for Extra Help benefits without being part of Medicaid or a Medicare Savings Program if you have income less than $22,590 for individuals or $30,660 for married couples living together in 2024.

  • You’ll pay no premium or deductible for Part D.
  • Your copayments will be no more than $4.50 for generics and $11.20 for brand-name drugs.

Starting in 2024, all Part D beneficiaries, regardless of qualifying for Extra Help, no longer have to pay copayments or coinsurance after their out-of-pocket spending for drug costs reaches the catastrophic coverage level, which is $8,000 in 2024. That spending includes payments made by other entities on your behalf, like Medicare’s Extra Help program. This is one of several provisions from the Inflation Reduction Act that limits Part D costs.

In the past, people who earned from 135 percent to 150 percent of the federal poverty level were eligible for partial Extra Help, with a lower level of assistance paying Part D premiums and copayments. In 2024, the income threshold for full Extra Help rises to 150 percent of the federal poverty level; partial Extra Help was eliminated. The U.S. Department of Health and Human Services estimates that more than 300,000 people who qualified only for partial benefits in the past will be eligible for full Extra Help in 2024.

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Keep in mind

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.

Video: What's Medicare Extra Help and Who Qualifies?

CMS will send you a letter identifying the plan you’ve 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 tool 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.

Need more help? Your State Health Insurance Assistance Program can assist you in applying for Extra Help or choosing a Part D plan.

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