It might be too hard to afford the medications you need. Medicare Part D covers prescription drugs, but it doesn’t cover all of the costs. If these out-of-pocket costs for your medications become too much to handle, don’t worry. You might qualify for Extra Help. This is a federal program that helps pay for some of the costs associate with prescription drugs.
Extra Help Eligibility Requirements
If your monthly income is below a certain amount each month, you may be eligible for Extra Help. Medicare’s Extra Help program also takes into account all of your assets when determining if you are eligible. Even if you believe your monthly income or amount in assets might be too high, you should still apply for Extra Help. You may still qualify. Requirements include:
- Medicare Parts A and B enrollment
- Combined savings and assets are not more than $14,100 if you are single or $28,150 if you are married
Some people automatically qualify for Extra Help and do not need to apply. You might be one of these people if:
- You have full Medicaid coverage
- Your state Medicaid program helps you pay your Part B premium
- You get Supplemental Security Income benefits
Qualification and eligibility requirements for Extra Help might change on a yearly basis. If you qualify one year, you might not the next. In a similar sense, if you do not qualify one year, you might the next.
What Does Extra Help Cover?
There are differing amounts of coverage in the Extra Help program. You might qualify for partial or full Extra Help depending on your monthly income and your assets.
Full Extra Help provides the most complete coverage. You will have a $0 premium and deductible, but only if you also have a basic Part D drug plan with a premium at or below the Extra Help premium limit for your area. Copayments for generic medications will be $3.35 and copayments for brand-name medications will be $8.35. After you reach $5,000 in out-of-pocket drug costs, your copayments will stop.
Partial Extra Help premiums depend on your monthly income. More information about this will be revealed when you apply for Extra Help. You will have to pay the monthly premium and an $83 deductible or the plan’s standard deductible, whichever is cheaper. You will also have to pay 15% coinsurance or the plan’s copayment, whichever is cheaper. When you hit $5,000 in out-of-pocket drug costs, you pay $3.35 for generic medications, $8.35 for brand-name medications, or 5% of the drug cost, whichever is greater.
Options If You Don’t Qualify for Extra Help
Even if you don’t qualify for Extra Help, your state might have programs in place to help you pay for your medications. Contact your local State Health Insurance Assistance Program for more information and to find out if your state offers these programs.
How to Apply for Extra Help
Applying for Extra Help is a simple process. All you need to do is go to the Social Security Administration website or click here. On this site, you can see if you qualify, apply for Extra help, return to an existing application, or find out more information.
We Can Help
While Extra Help provides coverage for prescription drugs, there are still gaps in your Original Medicare coverage. A Medicare supplement plan can ensure that all of your costs are covered. For example, if you need to go to the doctor, some Medicare supplement plans will cover the costs of your copayment. If you qualify for Extra Help, any prescription drugs prescribed during that visit will come at a lower cost to you.
We know this process is long and confusing, but it doesn’t have to be. Reach out to one of our friendly agents at (800) 310-2550 to learn more about your options about Extra Help or a Medicare supplement plan. To find out how much your complete coverage would be, feel free to view your Medicare supplement rates online.