Eligibility for Extra Help

People with limited incomes may qualify for Extra Help to help pay for their prescription drug costs. If you qualify for Extra Help, you will 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.

To find out if you are eligible for Extra Help go to www.ssa.gov (by clicking on this link you will be leaving our website) or call your local Social Security office.

The Low Income Subsidy (also called Extra Help) is for people with Medicare who have limited income and resources. Most people with Medicare have to apply directly for Low Income Subsidy with the Social Security Administration, but some groups are automatically eligible for Limited Income Subsidy.

People who automatically receive Extra Help:

• People with both Medicare and Medicaid (full dual eligibles)
• People who have a Medicare Savings Program (partial dual eligibles)
• People who receive needs based Supplemental Security Income (SSI) benefits but not Medicaid

If you do not fall into these categories you can apply for Extra Help directly with the Social Security Administration or your State Medicaid Office. If you have one of these additional programs you may get help paying your monthly Medicare Part B premium.

People who can apply for Extra Help

To qualify for Extra Help by applying directly, you must meet the conditions below:

Medicare Part A or B	Income and assets
You are entitled to Medicare Part A (Hospital Insurance). OR You are enrolled in Medicare Part B (Medical Insurance).	You are single and have an annual income of up to $16,245 and assets of less than $13,070.* OR You are married and have an annual income of up to $21,855 and assets of less than $26,120. *

*These asset limits include $1,500 per person for burial expenses. Assets include money in cash, checking accounts, savings accounts, money market accounts, stocks, bonds and other money you may have.

Note: These asset amounts are for 2012. Income and asset amounts can change each year.

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 Plan (MA-PD) 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 Medicare Prescription Drug plan or Medicare Advantage Prescription Drug Plan, your plan will update your Low Income Subsidy information as soon as possible.

For more information on Low Income Subsidy and BAE, you may visit the BAE policy on the Medicare Web site (by clicking on this link you are leaving our Web site).