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Medicare Benefits Prescription Assistance Seniors 65+

Medicare Extra Help

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Medicare Extra Help Program

Medicare Extra Help is usually granted along with the Medicare Savings Program if you are enrolled. If you qualify for one you usually qualify for the other. You also become a beneficiary  automatically if you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program. While the Medicare Savings Program helps with your out-of-pocket costs in Part A and B of your Medicare benefits, the Medicare Extra Help plan reduces your prescription drug costs in your Medicare Part D, the prescription drug plan portion of your Medicare benefits.

What Does Medicare Extra Help Cover?

Medicare Extra Help can reduce your required contributions to your drug expenses to a few dollars or even nothing for all your Medicare covered prescriptions. It does away with annual deductibles, covers most if not all Medicare prescription deductibles, monthly premiums and prescription co-payments or coinsurance for qualified beneficiaries. It can mean a savings of hundreds if not thousands of dollars annually on Medicare covered prescriptions, depending on your individual prescription roster. Any Medicare beneficiary with limited income and resources is eligible for the  Medicare Extra Help program.

Medicare Full Extra Help vs. Medicare Partial Extra Help

There are two tiers in the Extra Help program, a full Extra Help and partial Extra Help, depending on your income and resources. If you get approved for full Extra Help, your cost for a generic drug or a brand name they treat as a generic drug is $3.35 with your cost of a regular brand name drug at $8.35.

With partial Extra Help approval you still have impressive financial benefits, as you will have no or reduced monthly premiums or annual deductible. As to the specific drug costs from your Medicare plan’s formulary (covered drug) list, the costs is no more than 15% of the actual cost of the drugs. And if your health plan’s copay is less than that, you only pay that amount, not even 15%. You pay zero once you reach your plan’s out-of-pocket maximum.

Extra Help will contain your drug expenses to a point where drug costs become a non-issue in your overall budget. Even with just an average of three to four different prescriptions each month, this could mean serious savings.

You are encouraged to apply for the Medicare Extra Help benefit because it can mean manageable prescription expenses for a lifetime. Any Medicare beneficiary can apply, and is even encouraged to, even if their income is higher than the program limits due to the program’s layered parameters that may adjust your income downwards based on various factors.

Program guidelines for Medicare Full Extra Help:

2018 annual income limits are $16,632.00 for an individual and $22,464.00 for a married couple. Apply anyway if you have higher income as there are exceptions such as being residents of Hawaii or Alaska, you support other members of your family and others. Full Extra Help assets are capped at $9,060.00 for an individual and $14,340.00 for a married couple.

You do not need to count your home, car, personal possessions and life insurance. Help from someone else towards your household expenses is not counted as income. There is also a $20.00 “income disregard” on your unearned income, applied by the Social Security Administration, reducing it by $20.00.

Program guidelines for Medicare Partial Extra Help:

For Partial Extra Help, annual individual income is capped at $18,456.00 and a married couple’s income at $24,936.00. For Partial Extra Help you can own resources up to $14,100.00 as an individual or $28,150.00 as a married couple. Resources you have to count and disclose are bank accounts, stocks and bonds.

Who Can Apply for Medicare Extra Help?

Any Medicare beneficiary can apply for Extra Help. You will pay nothing at all for drug costs if you have Medicaid, or live in a nursing home or other institution, or get community or home based services. You will need to re-qualify annually for this Medicare benefit.

Not having to worry about prescription costs can be a godsend at any age, but can be especially life changing to any Medicare recipient offering improved health and financial relief in the golden years.

Medicare Extra Help Phone Number

Call 1-800-633-4227 (1-800-MEDICARE) or visit https://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html to sign up for Medicare Extra Help.


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