Medicare Extra Help Program Income Limits

If you are a Medicare Part D beneficiary struggling with the cost of prescription drugs, Extra Help may be the assistance you need. Extra Help is a low-income subsidy that offsets the cost of prescription drugs on your Medicare Part D plan. If your resources are below a certain threshold, you may qualify for assistance. Below, we help you understand how this program works with Medicare Part D, who is eligible, and how to apply.

Extra Help with Your Medicare Prescription Drug Plan Costs

The Extra Help program assists people with limited resources and lower incomes in paying for Medicare Part D prescription drug coverage.

Receiving Extra Help with your Medicare Part D can:

• Eliminate the Medicare Part D late enrollment penalty
• Reduce your out-of-pocket costs for prescription drugs
• Eliminate your monthly Medicare Part D premiums
• Reduce or eliminate your annual Medicare Part D deductible
• Eliminate the coverage gap, also known as the donut hole

As Extra Help removes the donut hole, your prescriptions will not cost more when you exceed the annual spending limit. The program saves beneficiaries nearly $5,000 in Medicare Part D costs per year.

If you are eligible for Medicaid or any of the following Medicare Savings Programs, you automatically qualify.

• Qualified Medicare Beneficiary (QMB)
• Specified Low-Income Medicare Beneficiary (SLMB)
• Qualifying Individual (QI)

With Extra Help, each generic prescription costs no more than $4.15, and each brand-name prescription does not cost more than $10.35.

If you did not enroll in Medicare Part D when you first became eligible, you do not have to pay the late enrollment penalty if approved for the program. Approval waives this cost if you would otherwise owe the penalty.

You should apply if you think you qualify but your income exceeds the limits. You may still be eligible for Extra Help when your income is over the limit in some scenarios. These cases include when you or your spouse:

• Provide financial support for other family members currently living with you
• Earn money by working
• Reside in Alaska or Hawaii

Resource limits also apply when determining your eligibility. To be eligible for partial Extra Help, your resources must be equal to or below $15,510 as an individual or $30,950 with burial expenses as a married couple living together. Without burial expenses, the resource limit for an individual is $14,010 and $27,950 for a married couple.

To receive full Extra Help benefits, the resource limit with burial expenses for an individual is $9,900 and $15,600 for a married couple. Without burial expenses, the resource limit for an individual to receive full Extra Help benefits is $8,400 and $12,600 for a couple.

The following examples count as resources:

• Real estate (primary residence excluded)
• Money in bank accounts (checking, saving)
• Stocks
• Bonds
• Mutual funds
• Individual Retirement Accounts (IRAs)
• Any cash

The following do not count as resources:

• Your primary residence
• Vehicle(s)
• Your personal belongings
• Burial expenses
• Interest on money slated for use as burial expenses

Contact Social Security for a comprehensive list of excluded resources.

Medicare Extra Help Limits 2022 Chart

The chart below displays the general limits for Extra Help with Medicare Part D in 2022. Still, individuals with higher income and resources may qualify for partial assistance in some circumstances.

Levels of Extra Help

If your income and resources are more significant than the limits above, you can still qualify for partial Extra Help. With Extra Help, there are levels of assistance that depend on your income and resources.

You can mail your Extra Help qualification letter to your Medicare Part D plan to help verify the level of Extra Help for which you qualify. Those dual-eligible to receive Medicare and Medicaid qualify for full Extra Help.

Applying for Extra Help with Medicare

To apply for Extra Help, you can fill out Form SSA-1020 on the Social Security website. You can also call Social Security to apply over the phone or visit your local Social Security office to apply in person.

Social Security will mail a letter to you informing you whether you qualify. You can choose a Medicare Part D prescription drug plan after becoming eligible for Extra Help. If you do not yet qualify, you can still look for a Medicare Part D plan that fits your budget and includes your prescriptions on the formulary.

FAQs About Extra Help with Medicare Part D

How to Find a Medicare Part D Prescription Drug Plan

Finding the right Medicare Part D plan can be confusing. Our licensed agents are Medicare experts dedicated to putting your needs first. We specialize in finding the best Medicare Part D plans for our clients. Our agents compare how each Medicare Part D plan covers prescriptions and dosages.

We work with beneficiaries nationwide to find the best plan for their needs and budget. Call us today at the number above to compare plans from top-rated carriers. Or, complete our online rate form to compare policies today.

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