What is Medicare Extra Help?

Medicare Extra Help Qualifications and Income Limits

Depending on your income and assets, you could qualify for either full or partial Extra Help. Both help with the cost of prescription drugs.

• Are dual-eligible (i.e., you are enrolled in both Medicaid and Medicare)

• Receive Supplemental Security Income (SSI)

• Qualify for a Medicare Savings plan

Medicare Extra Help Benefits

The amount of financial support you can receive from Extra Help depends 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 prescription 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 to 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 Advantage & Prescription Drug Plan Annual Enrollment Period (October 15 to 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.