The Medicare Extra Help program is a federal assistance program that provides financial aid to Medicare beneficiaries who have limited income and resources. It helps pay for costs associated with Medicare Part D prescription drug plans, including premiums, deductibles, and co-pays.
The program is administered by both the SSA and the CMS. The goal of the program is to make needed medications accessible to those who need them.
Benefits of the Extra Help Program
For those who qualify, Extra Help provides savings on prescription drug costs. Some of the program benefits include:
Lower Monthly Premiums
Extra Help covers some or all of the monthly premiums for Medicare Part D prescription drug plans. The amount covered depends on the level of Extra Help an individual qualifies for and the specific Part D plan they select.
Reduced Deductibles
With Extra Help, enrollees pay lower or even zero deductibles on their prescription drug plans. This allows beneficiaries to access their medication benefits without needing to pay a high upfront cost.
Low Co-pays or Coinsurance
Extra Help reduces co-pays, or coinsurance amounts for prescription drugs. In most cases, beneficiaries pay no more than $4.50 for generic drugs and $11.20 for brand-name drugs in 2024. The cost for 2025 have not been announced yet.
No Late Enrollment Penalty
Medicare imposes a late enrollment penalty on those who delay Part D enrollment and did not have creditable coverage from another source. Those who qualify for Extra Help do not pay the penalty.
Elimination of the Coverage Gap
The Medicare Part D “donut hole” (coverage gap) can cause additional expenses for beneficiaries. Those who receive Extra Help don’t have to worry about this. They receive consistent coverage with reduced costs all year. Please keep in mind; in 2025 the coverage gap will be eliminated.
Watch a quick video explaining the $2,000 drug cap for 2025
Who’s Eligible for Extra Help
For an individual to be eligible for Extra Help, they need to have income and assets at or below the amount set by the SSA each year. In 2024, the approximate eligibility requirements are as follows:
Income Limit: In 2024 the income limit for Single individuals is $22,590, while the income limit for married couples is $30,660. These amounts do not apply to Alaska and Hawaii, those states have their own income parameters.
Asset Limit: for individuals is $17,220, while the limit for married couples is $34,360. Assets include things like cash, bank accounts, investments, and property that is not your primary place of residence.
Click here to view the Medicare.gov fact sheet for Extra Help
How to Apply for Extra Help
Online Application: The quickest way to apply is online through the Social Security Administration at ssa.gov.
Phone Application: Call the SSA at 1-800-772-1213 (TTY: 1-800-325-0778) and apply over the phone. An SSA representative will guide you through the application process and can answer any questions you may have.
Paper application: Those who wish to use a papaer application can do so, click here for application. Once the application is completed, mail it to: Social Security Administration, Wilkes-Barre Direct Operations Center, P.O. Box 1020, WIlkes-Barre, PA 18767-9910.
In-Person Application: Visit your local Social Security office to apply in person. You may also be able to get assistance through certain Medicare health plans or local state health programs.
After submitting your application, the SSA will determine your eligibility and send you a notice explaining your benefits. If you qualify, you’ll automatically start receiving assistance with your Medicare Part D costs.
Extra Help and Medicaid
Many people who qualify for Extra Help may also qualify for additional savings programs either through Medicaid or their state’s Medicare Savings Programs (MSP). Those who are eligible for both Medicaid and Extra Help, receive the maximum level of assistance possible, which can result in very low (or even zero) out-of-pocket costs for prescription drugs.
Those aready enrolled in Medicaid, Supplemental Security Income (SSI), or MSP Programs, may automatically qualify for Extra Help do not need to apply. If that is the case, the beneficiary receives a notice from Medicare confirming eligibility for Extra Help.
Agents watch a quick YouTube video on non-commisisonable PDP plans
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Additional information
Anyone who may be eligible should apply. The application process is straightforward, and the savings can make a significant difference in Part D costs. This program can make a difference in the lives of those who require medications for a better quality of life and otherwise may not be able to afford it.