31 Jan Getting Help Paying for Medicare with Extra Help
Extra Help is a program that helps people with limited income and resources pay for their Medicare prescription drugs. It is also known as the Low-Income Subsidy (LIS). It is available regardless of whether you have original Medicare or a Medicare Advantage plan.
Who qualifies for Extra Help?
To qualify, your income and resources must be below certain limits. In 2023, resources for an individual must be below $15,160, and resources for a married couple must be below $30,240. Resources include items such as money in checking, savings, and retirement accounts, stocks, and bonds.
2023 income limits have not yet been released, but in 2022, the annual income limit for an individual was $20,385, and the annual income limit for a married couple was $27,465.
How do I sign up for Extra Help?
If you have Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you automatically qualify for Extra Help, and should get a purple notice about it from the Centers for Medicare & Medicaid Services (CMS). Save this notice!
If you don’t get Extra Help automatically, you can apply for it online or by calling the Social Security Administration at 1-800-772-1213.
If you qualify for Extra Help and don’t already have a Medicare Part D prescription drug plan, CMS will sign you up for one. But you can pick a different plan from the one that you were automatically signed up for, if you want to.
Even if your income changes in the middle of the year, you will continue to get Extra Help through the end of the calendar year.
How does Extra Help work?
There are two levels of Extra Help: full and partial. The level you qualify for depends on your income and resources. Each level has different costs.
If you receive full Extra Help:
- You won’t pay a premium or deductible for your Part D plan (as long as you are enrolled in a “benchmark” plan). A benchmark plan has a premium at or below a certain level set by CMS. If you have Extra Help and enroll in a plan with a premium above the benchmark, you must pay any amount above the benchmark.
- In 2023, you will pay a maximum of $4.15 for generic drugs and $10.35 for brand-name drugs.
- Once your total drug costs reach $7,400, you won’t pay anything for covered drugs
If you receive partial Extra Help:
- Your drug plan premium depends on your income.
- In 2023, your drug plan deductible won’t be more than $104.
- Your prescriptions won’t cost more than 15% of the cost of each covered drug.
- Once your total drug costs reach $7,400, you will pay a maximum of $4.15 for generic drugs and $10.35 for brand-name drugs.
What if I think I’m paying the wrong amount for my prescriptions?
If you qualify for Extra Help, and you think you’re paying the wrong amount for your prescription drugs, you should contact your drug plan and be prepared to provide proof that you have Extra Help. You can also call Medicare at 1-800-MEDICARE.
What else should I know about Extra Help?
In addition to lowering the cost of your prescription drugs, having Extra Help gives you a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in, or switch, drug plans.
Having Extra Help also eliminates any Part D late enrollment penalty you may have incurred if you didn’t enroll in Part D when you were first eligible.
If you were automatically enrolled into your drug plan and your plan loses benchmark status, CMS will send you a blue notice and automatically enroll you in a new plan.
But if you choose your drug plan and that plan loses benchmark status, CMS will send you a tan notice. You must switch to a new benchmark plan to avoid having to pay any amount above the benchmark amount.
It can be helpful to keep any notices you receive from CMS!
For more information about Extra Help, visit Medicare’s website.
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