Extra Help: Assistance paying for the Medicare drug benefit
Section IX.e. The Extra Help Program
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If your monthly income is up to $1,471 for singles ($1,991 for couples) and your assets are below specified limits (see chart below for details), you may be eligible for Extra Help, a federal program that helps you pay for some or most of the costs of Medicare prescription drug coverage.
Even if your income or assets are above the limit you may still qualify for Extra Help because certain types of income and assets may not be counted. For example, part of your earned income and your house will not be counted.
If you are enrolled in Medicaid, Supplemental Security Income (SSI) or a Medicare Savings Program (MSP), you automatically qualify for Extra Help. You do not have to apply for this extra assistance.
If you are not enrolled in one of the programs that automatically qualify you for Extra Help, you will have to fill out an application. You can do that through the Social Security Administration (SSA), using either the agency's print or online application, or at your local Medicaid office.
If you become eligible, you will get a Special Enrollment Period to enroll in a Medicare private drug plan. You will not have to pay a Part D premium penalty, even if you enroll in a Medicare private drug plan after you were first eligible.
Depending on your income and assets, you may qualify for either “full” or “partial” Extra Help. With either, you will never have to pay the full cost of your drugs as long as you take medications that are on your plan’s list of covered drugs (formulary) and you buy them at a pharmacy in your plan’s network.
If you use mail order to get your prescriptions, you may be able to get a 90-day supply of your prescription for the same amount of money that you would normally pay for a one-month supply. Your costs will be even lower after your out of pocket drug costs reach $4,850 (catastrophic coverage).
The chart below outlines how you qualify for and what you will pay under the different levels of Extra Help.
Even if you qualify for Extra Help, you must choose a private plan offering Medicare drug coverage in your area in order to get the Medicare prescription drug benefit. For Extra Help to fully cover your premium, you must choose a plan that offers basic coverage and has a premium at or below the Extra Help premium amount for your state. If you do not choose a plan, you will be automatically enrolled in one in most cases (in some cases, if you have Medicaid and certain kinds of employer coverage, you may not be enrolled or can ask not to be).*
You should check with 800-MEDICARE (800-633-4227) to make sure the plan you choose offers basic coverage.
Note: If you have Extra Help, you will be able to change Medicare private drug plans once a month.
For a list of Extra Help premium amounts by state, click on the MI Extra.
For the 2016 Income and Asset Limits Please click on the flier below.
If you have prescription drug insurance through a retiree plan, check with your former employer or union to see if you can get a Part D plan and still keep your current health coverage. If you cannot have both, you will want to think carefully about whether you should get a Part D plan, especially if your retiree health plan also covers your spouse or dependents who are not yet eligible for Medicare coverage.
*If you have Medicaid and have certain kinds of employer, retiree or union prescription drug coverage, you will not be automatically enrolled in a Part D plan. If you will lose your retiree or union health coverage by enrolling in a Medicare private drug plan, you may not want to take Medicare drug coverage. You will need to contact your state Medicaid office to find out what steps you should take to decline Part D coverage and still keep your Medicaid.