With up to 3 million more Medicare enrollees with low incomes and limited resources eligible in January 2024 for additional financial assistance to pay for their Part D prescription drug costs, federal officials are making a push to let older adults and people with disabilities know about the Extra Help program and how it is expanding.
The Department of Health and Human Services (HHS) estimates that nearly 300,000 people on Medicare currently enrolled in Extra Help but who only get partial benefits will be eligible for the full benefit next year under a provision of the prescription drug law signed in August 2022. This means they will pay no deductible for their Part D medications, no premiums for their Part D plans and lower copays for some of their prescription drugs.
According to HHS data, nearly 1.8 million Medicare beneficiaries were eligible for the full Extra Help program in 2021 but weren't enrolled, and an additional 1.2 million either were getting partial Extra Help benefits or were not enrolled but would be eligible for the full expanded benefit in 2024. About 13 million Medicare recipients are currently enrolled in Extra Help.
The income threshold for full benefits currently is 135 percent of the federal poverty guideline ($19,683 for an individual in 2023). Beginning in January 2024, the income threshold for full benefits will be raised to 150 percent of the federal poverty level ($21,870 for an individual in 2023).
Individuals enrolled in the Extra Help program are responsible for modest copays for their drugs until they reach the catastrophic phase of Part D; after that they don’t pay anything for their drugs. As of 2024, any Medicare beneficiary who enters the catastrophic phase will not have to pay anything more for their drugs. Starting in 2025 there will be an annual $2,000 cap on out-of-pocket expenses for everyone who gets their medications through a Part D or Medicare Advantage plan.
Extra Help is administered by the Social Security Administration (SSA). In addition to an annual income limit, the program includes a resources test. According to SSA, to qualify for Extra Help in 2023 an individual must have resources of less than $16,660; a married couple’s resources can’t be any more than $33,240.