How do I qualify for Medicare’s Extra Help?

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  • Contributor
  • March 4, 2018

Q: How do I qualify for Medicare’s Extra Help Program?

A: For lower income beneficiaries, there may be help through Medicare’s Extra Help program. If you have difficulty paying for prescriptions, the Extra Help program can make prescriptions more affordable than they would be with Medicare Part D alone.

Your income and resources determine the level of help you receive. Generally, enrollees eligible for Extra Help in 2018 will pay no more than $3.35 for each generic drug and $8.35 for brand-name drugs. Eligibility is limited to annual income of $18,210 for an individual and $24,690 for married couples.

In addition, resources must not exceed $14,100 for an individual and $28,150 for married couples. Resources do not include your car or home, but do include stocks, bonds, and bank accounts.

A recent law excludes some additional resources, making it easier for more seniors to get Extra Help: life insurance policies don’t count as resources, and financial assistance you receive from friends or relatives to help pay your household expenses is not considered income.

CMS estimates that up to 2 million Medicare enrollees may be eligible for Extra Help but not enrolled. If you think you might be eligible, apply online or call Social Security at 1-800-772-1213.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.