Summary: Medicare Extra Help is a program that helps individuals with Medicare pay for their prescription drug coverage. This low-income subsidy has income and resource limits that change annually. Find out who qualifies for Extra Help and what assistance it provides Medicare recipients. Estimated Read Time: 5 min
If you are a Medicare beneficiary enrolled in a Medicare Part D prescription drug plan, you may qualify for Extra Help to cover the cost of your prescription drugs.
When you have limited assets, income, and resources, the Extra Help program is available to help offset your Medicare Part D costs. Social Security and the Centers for Medicare & Medicaid Services (CMS) work together to provide this low-income subsidy to qualifying Medicare beneficiaries.
What is Medicare Extra Help?
Medicare Extra Help is a low-income subsidy for Medicare recipients with limited income and resources. This program helps offset the cost of Medicare Part D premiums, deductibles, copays, and coinsurances. Depending on your income, assets, and resources, you may receive full or partial Extra Help. The level of Extra Help that you receive will determine how much of your Medicare Part D costs are covered.
Most people who qualify for Extra Help will receive coverage for their drug plan’s entire premium, either the whole or partial deductible (depending on the level they receive), and a limit for out-of-pocket spending on individual drugs.
In addition to these benefits, those who qualify for Extra Help will also be exempt from paying the Medicare Part D late enrollment penalty if they delayed enrolling in Medicare Part D without creditable coverage.
Lastly, those who qualify for Extra Help will receive a quarterly Special Enrollment Period. Beneficiaries can only use these Special Enrollment Periods during the first three quarters of the year to change Medicare Part D plans. They will also be able to change plans during the Annual Enrollment Period, which runs from 10/15 to 12/7.
Who Qualifies For Medicare Extra Help?
If you have full Medicaid coverage, receive Supplemental Security Income (SSI), or qualify for a Medicare Savings Plan, you will automatically qualify and receive Extra Help. At this time, if you do not already have a prescription drug plan, you will be enrolled in one.
If you do not already have another form of Medicare assistance, you will need to apply for Extra Help benefits through the Social Security Administration. When applying for Extra Help, you may also apply for a Medicare Savings Program to get assistance with other Medicare costs. You can apply for Extra Help and Medicare Savings Programs at the same time.
Before applying for Extra Help, you’ll want to ensure you meet the income and resource limits. Below, we’ll detail the income limits for 2023 to qualify for the Medicare low-income subsidy.
Medicare Extra Help Income Limits in 2023
Below are the annual and monthly income and asset/resource limitations for Extra Help benefits in 2023. These limits change each year. If you don’t meet the requirements for full Extra Help, you may qualify for partial Extra Help.
The 2023 low-income subsidy income limit to receive Extra Help benefits are:
- Individual income limit: $21,870
- Married income limit: $29,580
You must also meet resource/asset requirements to qualify for a Medicare low-income subsidy. Below is a chart detailing resource limits for the different levels of Extra Help.
|Extra Help Level||Marital Status||2023 Resource Limit|
|Full Extra Help||Single||$9,090|
|Full Extra Help||Married||$13,630|
|Partial Extra Help||Single||$15,160|
|Partial Extra Help||Married||$30,240|
When applying for Extra Help, the following assets are counted towards your resource limit:
- Money in checking, savings, or retirement account(s)
Your home, car, burial plot, furniture, and other household and personal items are not considered resources when applying for Extra Help. If you have up to $1,500 set aside for burial expenses, that money will also be exempt from your resource limit.
How Does Extra Help Impact Out-Of-Pocket Costs?
Medicare Part D Extra Help lowers the out-of-pocket costs for your prescription drug coverage. Your out-of-pocket costs will be determined by the level of Extra Help you qualify for and the plan you are enrolled in.
|2023 Out-of-Pocket Costs When Using Extra Help|
|Full Extra Help||Partial Extra Help|
|Plan premium: $0||Plan premium: Varies based on income|
|Plan deductible: $0||Plan deductible: $104 maximum|
|Generic prescriptions: Up to $4.15|
Brand-name prescriptions: Up to $10.35
|All prescriptions: No more than 15% of the cost for each covered drug|
|Once your total drug costs reach $7,400, you’ll pay $0 for each covered prescription drug||Once your total drug costs reach $7,400, you’ll pay no more than $4.15 for each generic drug and $10.35 for each brand-name drug|
**Note that total drug costs include both what you pay and what your plan pays
How To Apply For Medicare Part D Extra Help
If you are eligible for Medicare and need help with prescription costs, you can apply for Extra Help anytime. You can apply for Medicare Part D Extra Help online through the Social Security Administration website or by calling your local Social Security office.
When applying for Medicare Extra Help, you’ll want to have the following documents for both you and your spouse:
- Bank statements
- Tax returns
- Individual Retirement Account (IRA) or 401(k) account balances
- Statements for any pensions, Veterans’ benefits, annuities, and Railroad Retirement Board benefits
If you are not enrolled in a Medicare drug plan, and your Extra Help application is approved, you will be automatically enrolled in a Part D plan. You’ll receive a letter detailing your drug plan coverage and the level of Extra Help that you qualified for.
If you receive Extra Help, you do not need to reapply yearly. As long as you meet the income and resource limits, you’ll keep the same Extra Help level. You will receive a letter if you no longer qualify or your Extra Help changes.
If your application for Extra Help is denied and you believe you should still qualify, you can submit a decision appeal. However, you may need to provide supporting documentation and there is no time frame in which a decision must be made.
You may enroll in a Medicare Part D plan before applying for Extra Help. By choosing a plan yourself, you can ensure your medications are included on the plan’s formulary.
Extra Help With Medicare Prescription Drug Plan Costs, Social Security Administration. Accessed July 2023
Help with Drug Costs, Medicare. Accessed July 2023