Medicare, the U.S. federal health insurance program, provides comprehensive healthcare coverage for people aged 65 and older, as well as for certain younger individuals with disabilities. One of its critical components is Medicare Part D, the prescription drug benefit program. For many, the costs associated with Medicare Part D can be a financial burden. This is where the “Extra Help” program, also known as the Low-Income Subsidy (LIS), comes into play.
What is Medicare Part D Extra Help?
Medicare Part D Extra Help is a federal program designed to assist individuals with limited income and resources in paying for their prescription drugs. This program can significantly reduce the cost of medications, insurance premiums, deductibles, and co-payments.
Benefits of Extra Help
The benefits of Extra Help are substantial. They include:
- Lower Prescription Costs: Reduced prices for prescription drugs, which can lead to significant savings.
- Reduced Premiums and Deductibles: Assistance with Medicare Part D premiums, deductibles, and co-payments.
- No Coverage Gap: Elimination of the Medicare Part D coverage gap, also known as the “donut hole.”
- No Late Enrollment Penalty: If you qualify for Extra Help and enroll in a Medicare Part D plan, you won’t have to pay a late enrollment penalty, even if you sign up late.
Who is Eligible for Extra Help?
Eligibility for Extra Help is determined based on income and resources. Generally, individuals with an income below a certain threshold and limited resources are eligible. The Social Security Administration (SSA) is responsible for determining eligibility.
| Income limit: | Resource limit: | |
| Individual | $21,870 | $16,600 |
|---|---|---|
| Married Couple | $29,580 | $33,240 |
Changes for 2024: Beginning 2024, the income threshold for Extra Help benefits is 150 percent of the federal poverty level (FPL). This is up from 135% of the FPL in 2023. This means more people will qualify for Extra Help. Also, everyone who is eligible for partial extra help will now automatically get full Extra Help.
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 enrollment into a new Medicare drug plan, if you don’t have one already.
How to Apply for Extra Help?
Applying for Extra Help is straightforward. You can apply online HERE through the Social Security Administration’s website, over the phone, or in person at a local Social Security office. You can also get help with the application by contacting one of our licensed agents. We are happy to help!
Navigating Medicare Part D and Extra Help
Understanding the nuances of Medicare Part D and the Extra Help program can be complex. Here are a few tips:
- Annual Review: Medicare Part D plans and benefits can change annually. It’s important to review your plan each year during the Open Enrollment Period to ensure it still meets your needs.
- Seek Assistance: Take advantage of resources like our local, licensed agents, who offer free, personalized assistance to Medicare beneficiaries.
- Stay Informed: Keep up with changes in Medicare and the Extra Help program by bookmarking our website or subscribing to our Medicare newsletter.
Conclusion
Medicare Part D Extra Help is a valuable resource for those struggling with the costs of prescription drugs. By reducing financial barriers, it ensures that more individuals have access to the medications they need. Understanding and applying for this benefit can lead to better health outcomes and reduced financial strain for eligible beneficiaries.
Looking for other ways to save on Medicare costs? Check out our blog on the Medicare Savings Program to see if you qualify for assistance with Part A and B medical costs.
