What is Extra Help and How Do I Apply?

by | Aug 18, 2022

With the increasing costs of everything, we are all looking to save money as much as we can. Medicare enrollees are no different. One of those increasing expenses is prescription drugs. While some measures have been taken to lower costs for Medicare-eligible citizens, these costs can easily get out of control. One program that can help with these costs is called Extra Help. In this article, we are going to learn more about the program that is Extra Help and how you can take advantage of its benefits.

What is Extra Help?

Extra Help is a program for those on Medicare with limited resources and income. This program helps pay for Part D premiums, deductibles, coinsurance, and other expenses. Acceptance into this program also means you will not have to pay a late enrollment penalty if you owe one.

How Do I Apply for Extra Help?

Some enrollees will get Extra Help automatically, while others will have to apply.

In the following situations, you will get Extra Help automatically…

  • You qualify for full Medicaid coverage (this is administered through your state)
  • You receive SSI (Supplemental Security Income) benefits from Social Security
  • You get help from your state to pay your Part B premium

If one of those situations does not apply to you, you can fill out an online application by clicking here or you can call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

How Do I Qualify for Extra Help?

You must have resources and income below a specific limit in order to qualify for Extra Help.

Resources like money in checking or savings accounts, stocks, and bonds will count against your limit.

While your home, one car, burial plots, furniture, other household items, and up to $1,500 for a burial plot do not count against your resource limit.

Resource and income limits increase each year.

The resource and income limits for 2022 are:

Resource Limit Income Limit
Individual $15,510 $20,385
Married Couple $30,950 $27,465

The limit is based on the previous year’s income. (So for 2022, your eligibility would be based on your 2021 income.)

What Happens if I Qualify for Extra Help?

If you are not enrolled in a Part D prescription drug plan already, Medicare will enroll you in one. If this is the case, you will get a green or yellow letter in the mail to tell you about your plan. This letter will tell you what your costs will be, depending on the level of Extra Help that you qualify for. If you are assigned a plan, you have the opportunity to change drug plans if you want.

Extra Help is for the calendar year, even if your income changes. If you meet the resource and income limits for the following year, you will keep your Extra Help. Medicare will let you know by mail if you no longer qualify or if they move you to a different drug plan.

What are the Levels of Extra Help?

There are two levels of Extra Help – full and partial. If you receive full Extra Help you will pay $0 for your plan premium and deductible. If you receive partial extra help, your plan premium will vary depending on your income, but your plan deductible will be no more than $99. Your costs for drugs will vary depending on your Extra Help level and if you also qualify for full Medicare benefits.

What Can I Do if I Don’t Qualify for Extra Help?

There are many other ways to save on prescriptions if you don’t qualify for Extra Help. Check out our blog “9 Ways to Save on Prescription Drugs” for some ideas.

If you have any questions about Extra Help or you need assistance with applying, we are always here for you. Feel free to give us a call or reach out to us here anytime!