Extra Help with Medicare Prescription Drug Costs
The Federal government has a program called Extra Help (also called the Low Income Subsidy-LIS-Program). This program helps those with limited income and resources pay for their prescription drug costs associated with Medicare Part D.
In order to use the Extra Help Program you must be enrolled in a Medicare Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug (MA-PD) plan. If you qualify for Extra Help, you will generally pay less in drug premiums and copayments. You also will be covered during the Coverage Gap and will not have to pay a Late Enrollment Penalty. Many people are eligible for these savings and aren't taking advantage of this. To see if you qualify for Extra Help, call:
Medicare at 1-800-MEDICARE (1-800-633-4227) 24 hours a day/7 days a week. TTY users call 1-877-486-2048; or
Social Security at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users call 1-800-325-0778; or
your State Medicaid Office; or
visit www.ssa.gov (by clicking on this link you will be leaving our website).
What are the benefits of receiving Extra Help?
There are four different levels of Extra Help that you may qualify for, based on your eligibility. The four levels of Extra Help cover 100%, 75%, 50% or 25% of your monthly Medicare Part D plan premium. Also, at the pharmacy, you will be charged lower copayments for your prescription drugs.
If you qualify for Extra Help and join a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan, you'll:
Get help paying for your plan's costs
Have no Coverage Gap
Have no Late Enrollment Penalty
Be able to switch plans at any time of year
Note: Extra Help will not pay for your monthly Medicare Part B premium. You must continue to pay your Medicare Part B premium.
Eligibility for Medicare Extra Help
In 2017, you may qualify for Extra Help if your yearly income and resources are below these limits:
For a single person: income is less than $18,090 and resources are less than $13,820.
For a married person living with a spouse and no other dependents: income is less than $24,360 and resources are less than $27,600 (Resources include money in a checking or savings account, stocks, and bonds. Resources don't include your home, one car, burial plot, up to $1,500 for burial expenses if you have put that money aside, furniture, and other household personal items).
Note that these amounts may change in 2018. Most people with Medicare have to apply directly with the Social Security Administration for Extra Help.
Some people automatically qualify for Extra Help. You may automatically qualify if you have Medicare and meet any of these conditions:
Have full Medicaid coverage (full dual eligibles)
Have a Medicare Savings Program (partial dual eligibles)
Get Supplemental Security Income (SSI) benefits (by clicking on this link you will be leaving our website)
To find out more about eligibility in Extra Help, please visit the Medicare website at https://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html (by clicking on this link you will be leaving our website).
Using the Best Available Evidence Policy (BAE)
You can use the Best Available Evidence (BAE) policy when the information that your Medicare Prescription Drug Plan (PDP) or Medicare Advantage Prescription Drug (MA-PD) plan has on your Low Income Subsidy is not up-to-date. Because of data exchanges, the right information is not always with your pharmacist or your PDP or MA-PD plan when you need it.
When this happens you can use the BAE to show that you qualify. Such evidence may be your award letter from the Social Security Administration, your Medicaid card or other proof that you were found eligible for Extra Help. When you give this information to your PDP or MA-PD plan, your plan will update your Low Income Subsidy information as soon as possible.
For more information on Low Income Subsidy and BAE, please visit the following websites (By clicking on the links below you will be leaving our website):
Enrollment disclaimer information:
This information is not a complete description of benefits. For more information contact the Plan. Limitations, copayments, and restrictions may apply. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.