What is Medicare Extra Help?

Extra Help is a program available to Medicare Part D beneficiaries who have limited income and resources. The program assists with and covers some of the costs of Medicare Part D. This includes plan costs, as well as costs for drugs themselves.

What costs does Extra Help Cover?

Medicare Extra covers the following costs from your Part D coverage:

• Premium: Extra Help covers your Part D Premium, so that your costs are $0.
• Deductible: Extra Help covers your Part D deductible, so that your costs are $0.
• Copay/coinsurance: Extra Help covers some of the costs of your prescriptions, so you pay less for generic and brand-name drugs.

In 2024, the costs you would pay if you get Extra Help are:

• Up to $4.50 for each generic drug
• Up to $11.20 for each brand-name drug
• $0 for each covered drug once your total out-of-pocket drug costs (including certain payments made on your behalf, like through the Extra Help program) reach $8,000

Additionally, if you are required to pay a late enrollment penalty on Part D, you will no longer be required to pay that fee while you get Extra Help.

Who gets Extra Help automatically?

You will get Extra Help automatically if you already get any of the following:
• Full Medicaid coverage
• Help from your state paying your Part B premiums
• Supplemental Security Income (SSI) benefits from Social Security

If you get Extra Help automatically, you will receive notice in the mail that will detail how much you’ll pay. You will also be enrolled in a Medicare Part D plan, if you are not in one already, and will be notified in the letter.

Once enrolled, your eligibility for Extra Help is reviewed each year. You will receive Extra Help benefits for as long as you remain eligible.

In the fall, you may get a notice if:
• You are no longer eligible for Extra Help, and will not receive benefits in the upcoming year.
• You get moved to a different drug plan for the upcoming year.

Who can apply for Extra help?

To be eligible for Extra Help, you must be below a certain level in income and resources. These limits may change each year. You must also live in the United States or the District of Columbia. If you don’t qualify for Extra Help now, you can reapply for Extra Help at any time during the year if your income and resources, or the requirements, change.

What is the resource limit for Extra Help?

To be eligible for Extra Help, your resources must be limited to $17,220 for a person or $34,360 for a married couple living together.

Resources include the value of the things you own. Some examples are:
• Real estate (other than your primary residence).
• Bank accounts, including checking, savings, and certificates of deposit.
• Stocks.
• Bonds, including U.S. Savings Bonds.
• Mutual funds.
• Individual Retirement Accounts (IRAs).
• Cash at home or anywhere else.

The things that are not counted include:
• Your primary residence.
• Personal possessions.
• Any vehicles.
• Property you need for self-support, such as rental property or land you use to grow produce for home consumption.
• Non-business property essential to your self-support.
• Life insurance policies.
• Burial expenses.
• Interest earned on money you plan to use for burial expenses.

What happens once I start getting Extra Help?

If you are not already in a Medicare Part D drug plan, you’ll be enrolled in one once your Extra Help starts.

You’ll get a notice by mail telling you about your new plan. We recommend that you check to see if the drugs and pharmacies you use are covered. If not, you may pick a different Medicare drug plan. You will get Extra Help for the rest of the calendar year. Even if your income changes in the middle of the year, you’ll get these benefits through December 31.

If Medicare enrolls you in a drug plan, you will receive a notice letting you know when your coverage begins.

What if I get enrolled in a Part D plan that isn’t right for me?

On Extra Help, you may be able to change plans one time during each of these periods:
• January–March
• April–June
• July–September

Your Part D plan will begin the first day of the next month. You can also switch drug plans each year during Medicare Open Enrollment (October 15–December 7), and the new plan will take effect on January 1.

What if I paid too much for my drugs after I started getting Extra Help?

If you are eligible for Extra Help, but haven’t started Part D yet, you are qualified for Medicare’s LI NET program. The LI NET (Limited Income Newly Eligible Transition) Program gives you temporary drug coverage in this transitionary period. Some of the things this program provides include:
• Coverage for all Part D covered drugs
• no network pharmacy restrictions
• ensures you’ll only be charged a reduced copayment for your drugs
• May cover prescriptions previously filled within a certain timeframe

If you paid too much for prescription drugs once you started getting Extra Help benefits, and weren’t yet in a Medicare drug plan, you may be able to get back some of what you paid. Keep your receipts, and call Medicare’s LI NET Program at 1-800-783-1307.

What if I don’t qualify for Extra Help?

You can apply or reapply for Extra Help at any time, if your income and resources change. If you don’t qualify for Extra Help, you can still enroll in a Medicare Part D plan to get some coverage for your prescription Medications. However, you’ll have to pay any premiums, deductibles, and any copayment or coinsurance for your prescription drugs.

Are there other ways to lower my drug costs?

If you don’t qualify for Extra Help, there may be other ways for you to save on drug costs. Some options to look into are:
• Your state may offer some help with drug costs. Check State Pharmaceutical Assistance Programs (SPAPs) to see if you qualify. Many states offer some type of coverage to help people with Medicare pay various plan costs. You may be required to get a Part D plan, but then the program will help with the drug costs that your Part D plan doesn’t cover.
• The company that makes your drug may offer some help paying for it. Many major drug manufacturers offer PAPs, or Pharmaceutical Assistance Programs, for people with Medicare drug coverage.
• Check with your doctor if you can replace your brand-name prescription with a generic drug, or a cheaper brand-name drug.
• Shop Medicare Advantage plans in your area. Many Medicare Advantage plans bundle Part D drug coverage into their plans, covering varying costs from your prescriptions. Many of these plans can even offer $0 premiums.