If you’re already enrolled in Medicare, you may also have a Medicare Prescription Drug Plan, but did you know that if you have limited resources, you could potentially be eligible for additional help? Learn more about the Medicare Extra Help Program below to see if you qualify.
Medicare Extra Help (Low-Income Subsidy)
The Medicare Extra Help Program—also known as Medicare Low Income Subsidy—was created to help Medicare beneficiaries with limited incomes pay for prescription drugs. Extra Help is not a replacement for Medicare Part D nor is it a plan on its own. It instead helps qualifying individuals pay for their Part D monthly premium, annual deductible, coinsurance, and/or copayments.
Who is eligible for the Medicare Extra Help Program?
To be eligible for Extra Help, you must be a Medicare beneficiary, have limited resources and income, and reside in one of the 50 states or the District of Columbia. The program eligibility limits can change from year-to-year, but the most up-to-date levels can be found at Medicare.gov.
Depending on your income and assets, you could qualify for either full or partial Extra Help. If any of the following are applicable, there’s a chance you’re automatically qualified for the Extra Help Program:
Are dual-eligible (enrolled in both Medicaid and Medicare)
Receive Supplemental Security Income (SSI)
Qualify for a Medicare Savings Plan
Medicare Extra Help Coverage & Benefits
The benefits you can receive from Extra Help depend on both your income and resources, but most people who qualify for Extra Help will pay:
No premiums (up to state benchmark; varies by state)
No drug deductibles
No more than $5.10 for generic and $12.65 for brand-name for each drug the plan covers1
Additionally, Extra Help beneficiaries have the following benefits:
Quarterly Special Enrollment Period – From January-September, you can join or switch Medicare Part D drug plans once every three months. This special enrollment period makes it so you don’t have to wait for the Medicare Annual Enrollment Period (October 15-December 7) to change plans. Any plans made outside of the Medicare Annual Enrollment Period then become valid the following month. This benefit can be especially helpful to those who may need to begin medications that are not on the current plan’s approved drug list.
No Part D Late Enrollment Penalty – Even if you enroll after you were first eligible to join a Part D plan and did not have other drug coverage.
Let us help you find the right Medicare coverage for you.
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1 https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d
