Getting Help with Drug Costs from Medicare’s Extra Help Program
Getting Help with Drug Costs from Medicare's Extra Help Program
The article below was originally posted by Medicare on Medicare.gov. To read the original article, click here.
What is Extra Help?
“Extra Help” is a Medicare program designed to assist people with limited income and resources pay Medicare drug coverage (Part D) premiums, deductibles, coinsurance, and other costs.
You also won’t have to pay a Part D late enrollment penalty while you get Extra Help.
Some people qualify for Extra Help automatically, and other people have to apply.
Extra Help isn’t available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. But there are other programs available in those areas to help people with limited income and resources. Programs vary in these areas. Call your State Medical Assistance (Medicaid) office to learn more.
Who gets Extra Help automatically?
You’ll get Extra Help automatically if you get:
Full Medicaid coverage
Help from your state paying your Part B premiums (from a Medicare Savings Program)
Supplemental Security Income (SSI) benefits from Social Security
You’ll get a letter about your Extra Help. It tells you things like how much you’ll pay, and your new Medicare drug plan, if you don’t have one already.
If you don’t automatically get Extra Help, you can apply for it by clicking the button below!
Or call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778. You can also contact your local State Health Insurance Assistance Program (SHIP) to get free help applying.
Who should apply for Extra Help?
In most cases, to qualify for Extra Help, you must have income and resources below a certain limit. These limits may go up each year.
Income and resource limits in 2023:
If you qualify for Extra Help
Medicare will automatically enroll you in a Medicare drug plan (Part D), if you don’t have one already. They do this so you can get the cost savings you qualify for.
You’ll get a letter telling you:
About your new plan. You can pick a different Medicare drug plan if you want.
What you’ll pay, depending on the “level” of Extra Help you get.
That you get Extra Help for the rest of the calendar year. Even if your income changes in the middle of the year, you’ll keep getting Extra Help through December 31.
If you meet the income and resource limits for next year, you’ll keep getting Extra Help. Medicare will mail you a letter only if:
- Your Extra Help changes.
- You no longer qualify for Extra Help.
- You get moved to a different plan for next year.
If you don’t get a letter from Medicare or Social Security, you’ll keep the same level of Extra Help and same plan for next year.
Starting January 1, 2024, everyone who is eligible for partial Extra Help will automatically get full Extra Help.
Even if you don’t qualify for Extra Help now, you can reapply for Extra Help anytime if your income and resources change.
Do you think you’re paying the wrong amount for your prescription(s)?
If you qualify for Extra Help and think you’re paying the wrong amount, here’s what you can do:
- Contact your drug plan. Your plan may ask for proof that you get Extra Help so they can correct your costs (see original article from Medicare.gov for examples of proof).
Tell your plan how many days of medication you have left. Your plan and Medicare will try to fix your issue before you run out of your medication.
Call Medicare at 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Medicare can tell you your level of Extra Help and help you get your costs fixed with the plan.
You may be able to get some money back if you:
Paid for prescriptions after you qualified for Extra Help.
Aren’t in a Medicare drug plan.
Keep your receipts with your prescription drug prices, and call Medicare’s Limited Income Newly Eligible Transition (LI NET) Program at 1-800-783-1307. TTY users can call 711.
Other ways to lower your prescription drug costs
Join Medicare drug coverage (Part D):
Compare Medicare drug plans to find a plan with lower drug costs.
Check if the company that makes your drug offers help paying for it.
Ask your doctor if you can take a generic drug, or a cheaper brand-name drug (if one is available).
Check costs for mail-order pharmacies. Sometimes using a mail order pharmacy is cheaper.
What do you want to do next?
Next Step: Learn about other health plans that lower costs.
Take Action: Apply for Extra Help.
Get details: Review sample letters about Extra Help.
For more information, please see Medicare.gov or call 1-800-MEDICARE (1-800-633-4227)(TTY users: 1-877-486-2048).
For additional questions, call us today at (800) 689-2800 or email contact@smsteam.net.
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Sources:
https://www.medicare.gov/basics/costs/help/drug-costs
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