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How do I qualify for Medicare’s Extra Help?

Medicare's Extra Help program can make prescriptions – and prescription drug plan premiums – more affordable.

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

A: Lower-income Medicare beneficiaries may receive financial assistance through Medicare’s Extra Help program. If you have difficulty paying for prescriptions, the Extra Help program – also known as the Low-Income Subsidy (LIS) – can make prescriptions and plan premiums more affordable than they would be with Medicare Part D alone.

Am I eligible for Extra Help?

Your income and resources determine the level of help you receive. You’ll automatically receive Extra Help if you have both Medicare and Medicaid, a Medicare Savings Program, or Supplemental Security Income, or Medicare only but also a limited income (note that the levels of Extra Help are different depending on your eligibility category).

To be eligible for Extra Help, your income in 2022 cannot exceed $20,385 for an individual or $27,465 for a married couple living together. In addition, resources must not exceed $15,510 for an individual and $30,950 for married couples (the financial limits are higher if you have dependents living with you, or if you live in Alaska or Hawaii).

Those are the income and resource limits for partial Extra Help; the limits for full Extra Help are lower. But starting in 2024, under the Inflation Reduction Act, full Extra Help will be available up to the limits that currently apply to partial Extra Help (the dollar amounts are inflation-adjusted each year, so they will be different by 2024). For full Extra Help, the current cap is 150% of the poverty level, while the cap for partial Extra Help is 150% of the poverty level. As of 2024, full Extra Help will be available up to 150% of the poverty level. And the higher resource limits that apply to partial Extra Help will also be used to determine eligibility for full Extra Help as of 2024.

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 beneficiaries 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. (The Social Security Administration has more details about what does and doesn’t count as resources).

Will Extra Help reduce my out-of-pocket costs?

Enrollees who receive full Extra Help in 2022 will pay no more than $3.95 for each generic drug and $9.85 for brand-name drugs. This is a valuable benefit that the Social Security Administration estimates is worth an average of about $5,000 per year. For Extra Help enrollees with lower incomes who are also enrolled in Medicaid, copays are limited to $1.35 for generics and $4.00 for brand name drugs.

In addition to having lower copayments, Extra Help enrollees also have their Part D plan deductibles reduced or eliminated altogether (depending on their income). The federal government also pays Part D premiums on behalf of Extra Help enrollees – up to a benchmark amount (this amount is different in each state; you can see which plans have zero premiums in your state for Extra Help enrollees), and eliminates the Part D late enrollment penalty for beneficiaries who would otherwise have to pay it.

Some beneficiaries, with income on the higher end of the eligible range, receive partial Extra Help, which reduces — but does not fully cover — the premiums and deductible for Part D. Partial Extra Help also reduces other out-of-pocket costs under Part D, but not as much as full Extra Help. As noted above, these beneficiaries will be eligible for full Extra Help as of 2024, under the terms of the Inflation Reduction Act.

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.

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Carla D Meert
2 years ago

I reapplyd for extra help By fax Feb 2020 my Rx co Silver Script says they were never notifiied. Carla Meert can you please verify for me by letter, or email msg. So I can get this resolved.. I called Silver Script, Medicare, who refered my to my county
Medicaide ofc who refered me to a local social service of. ( I never was involved with the offices) I get auto reimburse from thr company I retired from
So I need to resolve this. No one can help so far. Thank you.

Josh Schultz
2 years ago
Reply to  Carla D Meert

Hi Carla,

I removed it from your comment, but you should never post your Social Security Number on a public forum.

We are not the Social Security Administration — which is who you should probably contact to get this worked out. I would recommend calling them at 1 (800) 772-1213.

If you were approved for Extra Help or Medicaid (which means you automatically receive Extra Help), then you can use your approval letter from SSA or Medicaid at your pharmacy to pay only Extra Help co-pays for your medications.

If SSA says you have Extra Help but your Part D plan isn’t honoring the lower co-pays, then you may need to call 1-800-Medicare and ask them to work with your plan.

2 years ago

I would like to apply for extra help

2 years ago
Reply to  Jannie Motten

You can apply online or call Social Security at 1-800-772-1213.

Jaci presby
1 year ago

Mom had a in home nurse 2 days a week . She’s fantastic. My husband and I are disabled w my husband in dialysis. Mom has mainecare qwimby and Medicare she’s 89 w Alzheimer’s. She needs help with hygiene and a nurse familiar w this deisease which this nurse has and can transfer w us to hospice when time comes. We had help thru sr plus, but that money assistance is ending soon We

Theresa Dowd
1 year ago

I’m trying to determine eligibility for help with medicare premiums. On numerous charts the max. income for an individual is listed and says income can be higher if I have dependents. In 2005 I adopted my 3 grandchildren, two are still dependents, both have special needs. One child (19) is awaiting a disability determination and the youngest child is age 12. What is the income amount allowed for a single/individual (68yr old) with 2 dependents in order to qualify? Also, does “yearly income” include the SocSec benefits the children receive because I’m retired? Thank you.

Tanya Feke
1 year ago
Reply to  Theresa Dowd

If you are having a difficult time paying for Medicare premiums, you will want to see if you are eligible for a Medicare Savings Programs (for help with Part A and Part B) and/or Extra Help (for help with Part D). If you qualify for a Medicare Savings Program, are on Medicaid, or receive SSI, you automatically qualify for Extra Help. You should look into all of these options.

Dependents that are claimed on your taxes are considered for your Medicaid eligibility. Medicare Savings Programs and Extra Help base eligibility on single and marital status. That said, each state has different income and asset requirements for Medicare Savings Programs. I would encourage you to reach out to your State Medicaid Office at 1-800-MEDICARE. For Extra Help, reach out to Social Security at 1-800-772-1213.

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