We all need a little help sometimes. There’s no shame in that. This is especially true when it comes to something as important as your health care. Being able to afford your prescription medications is a major factor in this, as they can go a long way toward maintaining your health and any conditions you may have. If you have limited resources, Original Medicare can help cover many of your medical costs, but what about those prescriptions? Luckily, you can get extra help. Literally.
Extra Help for Medicare Drug Coverage?
Extra Help is a program run by the Social Security Administration (SSA) for Medicare insurance beneficiaries to assist them with the costs of prescription medications. While Medicare Part D plans strive to be affordable for those who enroll in them, if you’re on a fixed income with limited financial resources, the costs of prescriptions can add up. This program is a Part D counterpart to the host of Medicare Savings Programs (MSPs) that assist beneficiaries with Original Medicare costs.
Extra Help offers beneficiaries an estimated $5,000 worth of aid annually.
So, what exactly does Extra Help do for those who qualify? According to the SSA, the program offers beneficiaries an estimated $5,000 worth of aid annually, which can make a huge difference for seniors with limited finances. The aid from Extra Help comes in two ways. First, starting in 2024, the program allows any qualifying beneficiary to pay $0 for a Medicare drug insurance plan premium, as well as a $0 plan deductible. Second, Extra Help limits what you pay for prescriptions. In 2024, enrollees pay no more than $4.50 for a generic prescription and $11.20 for a name-brand drug. Together, these two aspects of Extra Help limit many of the costs associated with Medicare Part D, allowing beneficiaries to get the prescriptions they may need at a cost they can afford.
How Do I Qualify for Extra Help?
Extra Help is obviously very, well, helpful, but it’s not available to everyone. It’s designed to help those with limited financial resources. In order to enroll in the program, you need to tick a few boxes.
Anyone who enrolls in Extra Help must also be enrolled in Medicare, live within one of the 50 states or the District of Columbia, and must meet the financial requirements of the program. Currently, your combined savings, investments, or real estate may not be valued more than $14,790 for a single person or a married person not living with their spouse or $29,520 if you’re married. That number doesn’t include the value of your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts, or back payments from Social Security or Supplemental Security Income (SSI).
In some cases, you may automatically qualify for Extra Help. Generally, this is due to your enrollment in another government program aimed to assist those with limited financial resources. For example, if you receive full Medicaid coverage, you’re automatically eligible for Extra Help. The same goes for people enrolled in MSPs or receiving SSI benefits.
If you receive full Medicaid coverage, you’re automatically eligible for Extra Help.
If you automatically qualify for Extra Help, you’ll receive a notice in the mail informing you. You may receive a purple notice if you qualify through an MSP or SSI benefits or have Medicaid and Medicare insurance coverage. There’s also a chance you may receive a yellow notice, which is an auto-enrollment notice. If you get the yellow notice, you’ll be automatically enrolled in Extra Help unless you decline the coverage. You’ll also be enrolled in a Medicare Part D prescription drug plan if you don’t have one. A final notice you may receive is an outreach notice, which lets you know you may qualify for Extra Help.
How Do I Enroll in Extra Help?
If you qualify for Extra Help, it’s pretty easy to submit an application. Simply go to the Social Security’s Extra Help application site and fill out the form. By filling out the form, you’ll also be starting the application process to enroll in an MSP. The SSA will take the information from your application and share it with your state. Your state should then contact you to help you enroll in an MSP. You can opt out of this, however.
If you need additional assistance enrolling in Extra Help, you can always call the Centers for Medicare & Medicaid Services (CMS) at 1-800-MEDICARE (TTY 1-877-486-2048) or visit https://www.medicare.gov/. You can also get in touch with your State Health Insurance Assistance Program (SHIP) for guidance through the process.
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If you’re struggling financially or on a fixed income, the added burden of needing prescription medications to maintain your health is one thing you don’t want to worry about. Instead of skipping these sometimes-critical drugs, programs like Extra Help can make these necessities affordable and remove at least one significant burden from your shoulders. If you have limited financial resources, knowing that at least your health care is protected and covered can make a big difference.
