The Medicare Extra Help program (Medicare low-income subsidy) offers considerable savings on prescription drug costs for eligible beneficiaries. The program helps to offset the cost of some prescription drugs for income-eligible people who have Medicare Part D and who have limited resources. The Extra help program may also help lower enrollees out-of-pocket-costs for prescription drugs.
What is Medicare Extra Help?
If you have any difficulties paying for your prescription drugs every month or problems whenever your health care provider prescribes new medication, the Medicare Extra Help program provides with that. Many Medicare beneficiaries may qualify for the program without knowing they are eligible.
The Social Security Administration (SSA) estimates that the Extra Help program offers an estimated annual $5,100 savings for eligible Medicare beneficiaries.
Savings Provided by Enrolling in the Extra Help Program
There are additional savings for people who are eligible for the program besides the offsets to prescription drug costs. There are also savings on monthly premiums, the annual deductibles, and prescription co-payments related to a Medicare prescription drug plan in addition, you do not pay the late enrollment penalty when enrolling in a Medicare part D drug plan.
One important savings benefit for many eligible Medicare beneficiaries is that Extra Help eliminates the coverage gap, commonly referred to as the “donut hole”. For more details on the coverage gap visit The Medicare Part D Donut Hole.
How Do I Apply for Extra Help?
The first step to finding out if you qualify for Extra Help is to complete the application for Extra Help with Medicare Prescription Drug Costs. Complete the application and submit it at your local Social Security Administration field office. You can apply for Extra Help online.
You automatically qualify for Medicare Extra Help if you have benefits from other programs, which include:
- Both Medicare and Medicaid
- Both Medicare and Supplemental Security Income benefits
- You receive help from Medicaid to pay your Part B premiums
If you receive assistance with paying your Medicare Part B premiums, you belong to a Medicare Savings Program.
Prescription drug costs in 2022 for Medicare Part D beneficiaries who receive Extra Help are no more than $3.95 for generic drugs and no more than $9.85 for brand-name prescription drugs.
What are the Medicare Extra Help Income Limits 2022?
You must meet the income limits requirement and the resources limit. The limits change every year, so you must look at the eligibility limits for the year you apply for Extra Help, such as the 2022 limits.
Understanding the Extra Help with your Medicare Prescription Drug Plan guide indicates that the income limits for Extra Help benefits for 2022 are $20,385 for individuals and $27,465 for married couples. Even if your annual income is higher, you may still qualify for Medicare Extra Help under certain circumstances.
Some income does not count, including:
- Housing or home energy assistance
- Food stamps
- Earned income tax credit payments
- Scholarships or education grants
- Medical treatment or drugs
- Disaster assistance
The resources limit to qualify for Extra Help is $15,510 for an individual and $30,985 for a married couple who live together. Examples of countable resources include:
- Real estate that is not your primary residence.
- Bank accounts which will include your checking and savings accounts and certificates of deposit.
- Stocks and bonds including U.S. Savings Bonds.
- Individual Retirement Accounts
- Cash on hand that you have at home or any other location.
- Mutual funds
Some resources do not count, including, the primary home that you reside in, your vehicle(s), personal possessions, and jewelry or home furnishings that you cannot easily convert to cash. Examples of other resources that do not count are property that you need for self-support, such as rental property, life insurance policies, burial expenses, or interest earned on money that you plan to use for burial expenses.
If you have questions about whether resources or income count towards your eligibility for the Medicare Extra Help program, ask the representative taking your application or call 1-800-MEDICARE (1-800-633-4227).
Do I Automatically Qualify for Extra Help Every Year?
If your income or your resources change next year, you may no longer qualify for the program. Additionally, you will likely no longer qualify for one of the programs that automatically qualified you for Medicare Extra Help.
If you automatically no longer qualify for the program, you will receive a notice, along with an application in the mail.
It is your responsibility to report any changes in income or resources. The award notice you receive explains how to report changes in income and resources.
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