What is the Extra Help Program, and How Can You Benefit?

Medicare Part D Extra Help Program

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 2018, the costs are $3.35 for each generic drug and $8.35 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.

Unfortunately, some in Washington are looking to make changes to Extra Help. These changes would limit what treatments can be prescribed and lead to Extra Help beneficiaries getting cheaper and less effective medications. Stay tuned for updates, and write your Congressperson if you’d like to see the program stay the same. 

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

How to Apply

If you do not automatically qualify, you can apply for Extra Help through Social Security. To apply, your annual income for 2018 must be $18,210 for an individual or $24,690 for a married couple living together. See what is not counted as income here. The resource limit for 2018 is $12,600 for a single, or $25,150 for a married couple. Resources include money in a bank account, stocks, and bonds. For more information on Extra Help, see this brochure from Social Security.

To apply online for Extra Help, go here. Alternatively, you can call 1-800-MEDICARE, visit your local Social Security office, or visit 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.

Extra Help Medicare Part DRelated Links

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3 Ways to Save Money on Your Health this Fall

Medicare Special Enrollment Periods

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