Extra Help with Prescription Medications: What is It, and How do You Apply?

medicare, extra help, medicare part d, help with costs
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This article was updated on December 3, 2020.

If you are living on limited income and resources, you may be able to qualify for Extra Help paying for your Part D costs. Nearly 11 million Americans receive benefits from Extra Help.

Extra Help is also referred to as the Low-Income Subsidy (LIS). With Extra Help, you pay less in premiums and copayments or coinsurance for your prescription drug coverage. In addition, you are covered for the donut hole coverage gap, and relieved from paying the Part D late enrollment penalty. You must be enrolled in a Part D prescription drug plan to receive the benefits of Extra Help.

Drug costs under Extra Help

For 2021, the costs are $3.70 for each generic drug and $9.20 for each brand-name drug. Remember, though, that Extra Help only helps with paying the Part D premiums, not Part B.

There are four levels of Extra Help that cover either 100%, 75%, 50%, or 25% of your monthly Part D premium. The level you get depends on your level of income and resources. Make note that if you have a Medicare Advantage prescription drug Part D plan, your premium will not be lowered.

Some qualify automatically

Some people automatically qualify for Extra Help. You qualify for Extra Help if:

  • You have full Medicaid coverage
  • You get help paying your Part B premiums via a Medicare Savings Program
  • You receive Supplemental Security Income (SSI) benefits

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How to apply

If you do not automatically qualify, you can apply for Extra Help through Social Security. To apply, your annual income for 2021 must be below $19,140 for an individual or $25,860 for a married couple living together. See what is not counted as income here. The resource limit for 2021 is $13,110 for a single, or $26,160 for a married couple. Resources include money in a bank account, stocks, and bonds. For more information on Extra Help, see this Extra Help page from Medicare.gov.

To apply online for Extra Help, visit the Social Security website here. Alternatively, you can call 1-800-MEDICARE, call Social Security at 1-800-772-1213, or contact your state Medicaid office.

If you don’t qualify for Extra Help right now, you can reapply in the future. Your local Medicaid office or your local SHIP program can help you find other ways to save if you don’t qualify at this time.

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