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What is Medicare Extra Help?

Senior woman in pharmacy talking to the chemist or pharmacist explain effects of a drug

Just the Essentials…

  • Medicare Extra Help is a government-regulated program that helps certain low-income Medicare beneficiaries pay for Medicare Part D: Prescription Drug Coverage.

  • Your annual household income and certain resources will count toward your Extra Help eligibility.

  • The Extra Help program may allow you to pay less (or in some cases, nothing) in out-of-pocket expenses related to medically necessary prescription drugs.

  • You can apply for Extra help through the Social Security Administration (SSA) and receive assistance with doing so.

What should I know about Medicare Extra Help?

Medicare Extra Help is a medication expense assistance program that is managed by the U.S. federal government. Through Extra Help, certain low-income individuals may be eligible for financial assistance in paying for the costs of their medically necessary Medicare Part D prescription drugs.

If you qualify for Extra Help, you may pay less (or in some cases, nothing) out-of-pocket for Medicare Part D: Prescription Drug Coverage plan premiums, copays, and yearly deductibles. Of course, how much you will or will not be required to pay is entirely dependent on your income level.

As of 2021, copays and coinsurance for drug coverage under Extra Help cost no more than $3.70 for each generic drug, and $9.20 for each covered brand-name drug.

Learn more about who may qualify for Extra Help, and how you can apply for it, right here courtesy of MedicareInsurance.com.

Who might qualify for Extra Help?

As long as you meet certain income and resource limits, you may qualify for Extra Help. As of 2021, you must make less than $19,320 in yearly income ($26,130 for married couples) and own less than $14,790 in resources ($29,520 for married couples) in order to qualify.

The following resources typically count toward your qualification status:

  • Money in a checking or savings account
  • Stocks
  • Bonds

The following resources typically do not count toward your qualification status:

  • Your home
  • One car
  • Burial plots
  • Up to $1,500 you may have set aside for burial expenses
  • Furniture
  • Other household items and personal belongings

Some people may qualify for Extra Help automatically if they already have Medicare and also receive any of the following:

  • Full Medicaid coverage
  • State Medicaid assistance with paying for Part B premiums (e.g. from a Medicare Savings Program)
  • Supplemental Security Income (SSI) benefits

Even if you don’t qualify for Extra Help, you may still be eligible for certain state programs that can help you cover prescription drug costs. Contact your local Medicaid office or your State Health Insurance Assistance Program (SHIP) as soon as possible to learn more.

Remember, if your income or resources change at any point, you can reapply for Extra Help at any time.

How can I apply for Extra Help?

The Social Security Administration estimates that the Extra Help program is worth about $5,000 per year.

You can apply for Extra Help right here, or by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778). From there, you can apply over the phone, request a paper application, or schedule an appointment to apply at your local Social Security office.

Please keep in mind that the Extra Help application does not enroll you in a Medicare Prescription Drug Plan, and that you do not need to be enrolled in a Medicare Part D Prescription Drug Plan in order to apply for Extra Help.

If you need assistance completing your Extra Help application, check out these guidelines in English or in other languages via the SSA’s Multilanguage Gateway.

Common questions you may have after qualifying for Extra Help.

Once you are deemed eligible to receive Extra Help, you may still have a few outstanding questions about the program and how it works. The following are some common questions for those who have just recently qualified for Extra Help:

How long will I receive Extra Help?

After qualifying for the Extra Help program, you’ll receive its benefits as long as you meet the year’s income and resource limits. Even if you automatically qualify this year, this may not be the case next year, as changes in your resources and income can affect your ability to receive Extra Help benefits.

How will I know if I no longer qualify for Extra Help or if there are changes to my copay costs?

Depending on the exact circumstances, there are a few different ways you will be notified about changes to your Extra Help coverage. 

For example, if you got Extra Help at one point, but no longer automatically qualify for next year, you will receive a letter (printed on grey paper) in the mail by the end of September. In this case, you may still qualify for some prescription drug cost assistance, but you will have to apply to find out.

If your copays have changed for next year, you will receive a notice (printed on orange paper) in the mail in early October that will inform you of the new amounts.

If you do not receive a notice from Medicare, you can expect your Extra Help benefits to continue as normal for next year.

If I think my drug costs are wrong, what should I do?

If you aren’t sure that you’ve been being charged the correct amount for your prescription drug coverage, the first thing you should do is call your drug plan. If you do, your drug plan may ask you to give them information that will help them verify the level of Extra Help coverage you are eligible to receive.

If I’ve been paying too much, can I get reimbursed?

If you discover that you have paid more than required for prescription medications since you qualified for Extra Help and you are not enrolled in Medicare drug coverage, you may be able to get some of your money back.

Because of this possibility, it is wise for you to keep all receipts that contain information about your out-of-pocket prescription drug costs. To learn more about this option, contact your drug plan or call Medicare’s Limited Income Newly Eligible Transition (NET) Program at (1-800) 783-1307.

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