Medicare beneficiaries with a lower income may qualify for Extra Help paying monthly premiums, yearly deductibles, and copays relating to Part D prescription drug coverage. Assistance could be available to you.

Keep reading to learn more about Extra Help eligibility, applications, appeals, and more.

What Does Extra Help From Medicare Mean?

Extra Help is a program that helps lower-income Medicare beneficiaries pay Part D costs. Applying for assistance doesn’t automatically sign you up for a Part D plan.

If you’re eligible for Extra Help, you won’t be subject to a late enrollment penalty when joining a Part D plan. Those that qualify should check with their drug plan to ensure the plan has the correct level of Extra Help applied to coverage.

Medicare beneficiaries that qualify for Extra Help get assistance from Medicare to pay Part D coverage such as monthly premium, annual deductible, coinsurances, and copays.

Who Can Qualify For Medicare Extra Help?

To be eligible for Extra Help you must have Medicare, be low-income, and have limited assets. Extra Help is only available to those residing in one of America’s 50 states or the District of Columbia.

You must enroll in a Medicare-approved prescription drug plan for benefits to start. However, you don’t need to be enrolled in a plan to file for benefits.

If you already have Medicare and Medicaid, don’t apply for extra help because you already have those benefits. Those participating in Programs of All-Inclusive Care for the elderly (PACE), Medicare Savings Programs, and Supplemental Security Income (SSI) benefits automatically qualify for Extra Help.

If you believe you should be receiving benefits and you’re not, contact your local Social Security or Medicaid office. Even if you don’t qualify automatically, we suggest you apply.

What are the income limits for Extra Help with Medicare in 2022?

In 2022, the combined income limit for married couples living together is $26,130. For singles or those not living with a spouse, the income limit is $19,320.

If your income is slightly higher than the limits, you can still apply, it’s just possible the application will be denied.

Resource limits will affect eligibility. Examples of resources include funds in bank accounts, stocks, bonds, mutual funds, real estate, Individual Retirement Accounts, and cash.

Your primary residence doesn’t count toward real estate resource limits. Cars, burial expenses, and personal belongings don’t count as resources.

What are the Levels of Extra Help?

There are different levels of Extra Help, depending on your level of need. Some people will be eligible for Medicare and Medicaid. Others may only qualify for Extra Help covering a larger portion of Part D costs.

What Does Medicare Extra Help Pay for?

Medicare Extra Help will contribute to paying the cost of your Part D premiums, deductibles, copayments, and coinsurances. Also, Extra Help waives late enrollment penalty fees.

In 2022, you won’t pay more than $3.95 for generic medications and $9.85 for brand-name prescriptions when you have Extra Help.

Extra Help waives the coverage gap for beneficiaries that would otherwise fall into the Medicare donut hole. It’s estimated that Extra Help saves beneficiaries a little over $5,000 annually.

What Happens When I Start Receiving Extra Help?

Once you receive Extra Help you need to enroll in a Part D plan if you don’t already have one. The cost of your prescription coverage will be lower.

You can expect lower premiums, deductibles, coinsurances, and copayments. You’ll need to complete a review of eligibility periodically to ensure your benefits to income ratio is accurate.
Remember to compare Part D plans each year to ensure your policy continues to provide you with the most value.

What Happens if I No Longer Qualify for Extra Help?

If you no longer qualify for Extra Help, you’ll be responsible for your drug plan premium and may want to find a different policy. You should get notified in the fall before the new year if you’re no longer eligible for Extra Help.

For those that miss the Annual Enrollment Period, you may be able to change plans during the Open Enrollment Period for Medicare Advantage. Be sure to choose the policy that saves you the most annually.

Sometimes, mail-order prescriptions can help lower your out-of-pocket costs.

FAQs

How do I apply for extra help with Medicare?

Many Medicare beneficiaries apply for Extra Help online. To apply over the phone call Social Security. You can apply via a paper application, or you can schedule a face-to-face appointment at your local Social Security office.

How long does it take to get Extra Help with Medicare?

Once you apply for Extra Help your request can take anywhere from a few days up to 14 days to process. The length of time a response takes depends on your circumstances.

Submitting all necessary documents can make the process smooth.

What if I’m wrongfully denied Extra Help?

If you believe your application for Extra Help should be approved but you’re denied coverage, you can file an Appeal of Determination for Extra Help with Medicare Prescription Drug Plan Costs.

Follow the instructions for filing an appeal to determine your eligibility.

How Do I Find the Best Medicare Plans to Compliment Extra Help

Those with Extra Help may find Medicare Advantage plans appealing since the premiums are so low. But a Medicare Supplemental plan could potentially save you more money in the long run.

Working with a licensed insurance agent is a great way to determine which options make the most sense for you and your situation. Our agents’ time and knowledge are free to you!

Give us a call to get a personalized Medigap quote. Or fill out the online rate form to get the best rates in your area now.

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by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.