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.
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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 $3.95, and each brand-name prescription does not cost more than $9.85.
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.
What are the Medicare Extra Help Income and Resource Limits for 2022?
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.
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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.
| Extra Help Level | Marital Rights | 2022 Extra Help Resource Limit | 2022 Extra Help Limit with Burial Expenses | 2022 Extra Help Income |
|---|---|---|---|---|
| Full | Single | $8,400 | $9,900 | $20,625 |
| Full | Married | $12,600 | $15,600 | $27,705 |
| Partial | Single | $14,010 | $15,510 | $20,625 |
| Partial | Married | $27,950 | $30,950 | $27,705 |
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.
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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
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Sources:
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- Extra Help, Medicare . Accessed April 2022.
https://www.medicare.gov/Pubs/pdf/11215-No-Longer-Automatically-Qualify-Extra-He.pdf - Find Your Level of Extra Help, Medicare . Accessed April 2022.
https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d - Prescription Help, SSA . Accessed April 2022.
https://www.ssa.gov/benefits/medicare/prescriptionhelp.html
Good afternoon,
I turned 64 years on 27 September 1957. I am a retired Veteran with a 70 % disability awarded in 2020. I use Tricare Prime and reside in Corpus Christi, Tx.
1. When should I enroll in Medicare?
2. What plans would I need to have? A or B, D?
Please advise
Hi Kay – firstly, thank you for your service.
1) We recommend you enroll in Medicare Parts A and B during your Initial Enrollment Period, around your 65th birthday. Medicare does not consider TRICARE to be creditable coverage for Parts A and B, so you would face late penalties when you eventually enroll in Medicare. When you enroll in Medicare Parts A and B, you’ll automatically enroll in TRICARE For Life (TFL). TFL acts as a wraparound for Medicare and covers certain costs.
2) Per the above, we recommend you enroll in Parts A and B. If you’ve paid Medicare taxes for at least 40 quarters (10 years), you’ll get Part A premium-free. With TFL, you won’t need to buy extra prescription drug coverage for as long as you have TFL, as it is creditable for Part D.