Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS). If your monthly income is up to $1,538 in 2018 ($2,078 for couples) and your assets are below specified limits, you may be eligible for Extra Help (see the Extra Help income and asset limit chart for details).
Note: The above income limits include a $20 income disregard that the Social Security Administration (SSA) automatically subtracts from your monthly unearned income.
Even if your income or assets are above the eligibility limits, you could still qualify for Extra Help because certain types of income and assets may not be counted, in addition to the $20 mentioned above.
If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help regardless of whether you meet Extra Help’s eligibility requirements. You should receive a purple-colored notice from the Centers for Medicare & Medicaid Services (CMS) informing you that you do not need to apply for Extra Help.
The Extra Help program offers the following benefits:
- Pays for your Part D premium up to a state-specific benchmark amount
- Lowers the cost of your prescription drugs
- Through 2018, gives you a monthly Special Enrollment Period (SEP) to enroll in a Part D plan or to switch between plans (Beginning in 2019, the Extra Help SEP will be available once per calendar quarter during the first nine months of the year. If you have Extra Help, you will no longer be able to use the SEP once per month to make changes to your prescription drug coverage. You should use Fall Open Enrollment during this time to make prescription drug coverage changes.)
- Eliminates any Part D late enrollment penalty (LEP) you may have incurred if you delayed Part D enrollment
Depending on your income and assets, you may qualify for either full or partial Extra Help. Both programs provide assistance with the cost of your drugs. To receive such assistance, your prescriptions should be on your plan’s formulary and you should use pharmacies in your plan’s network.
Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.
If you are eligible for Extra Help and have other creditable drug coverage (such as certain retiree coverage), you should evaluate your costs and coverage to decide whether to enroll in Part D and Extra Help or to keep your current drug coverage. Be sure to ask your former employer or union if you can get a Part D plan without losing the retiree benefits you want to keep, and check if disenrolling from retiree drug coverage makes you ineligible for other retiree health benefits. If you cannot have Part D and your retiree benefits, or if keeping both is not cost-effective, think carefully about whether you should get a Part D plan, especially if your retiree plan also covers your spouse or dependents. If you later want Part D, you will have a two-month SEP after you lose creditable coverage.
Finally, those with Medicaid and certain kinds of employer, union, or retiree drug coverage may in some cases not be enrolled in Extra Help or can ask not to be. Contact your local Medicaid office to learn how to decline Part D without losing your Medicaid coverage. If you later want Part D, you can enroll at any time without penalty if you are still enrolled in Medicaid or eligible for Extra Help.