Navigating the world of Medicare and prescription drug coverage can be challenging, especially when you’re on a fixed income. For many retirees and Medicare beneficiaries, the cost of medications can add up quickly and become a significant financial burden. Thankfully, there’s a program designed to help ease this strain — the “Extra Help” program. Below, we’ll explore everything you need to know about this vital benefit, its eligibility requirements, and how to apply.
What Is the “Extra Help” Program?
The “Extra Help” program, also known as the Low-Income Subsidy (LIS), is a federal assistance program run by the Social Security Administration (SSA). It is designed to help Medicare beneficiaries pay for their prescription drug costs under Medicare Part D. This includes assistance with premiums, deductibles, and copayments for medication. Depending on your income and resources, you may qualify for full or partial Extra Help, significantly reducing your out-of-pocket expenses.
One of the best aspects of this program is that if you qualify, you can save thousands of dollars annually on prescription drug costs. Additionally, individuals receiving Extra Help are exempt from the Medicare Part D late enrollment penalty.
Who Qualifies for Extra Help in California?
Eligibility for Extra Help is based on your income and financial resources. The exact limits are subject to changes each year, but for 2023, you generally qualify if:
- Your annual income is below $20,385 for individuals or $27,465 for married couples living together. (Certain exclusions such as assistance from others to pay for household expenses may not count as income.)
- Your combined savings and resources are limited to $15,160 for individuals or $30,240 for married couples. (This includes things like bank accounts, stocks, and bonds but excludes your primary home, vehicles, and personal belongings.)
If you’re part of the Medi-Cal program (California’s Medicaid), you’re already deemed eligible for Extra Help and don’t need to apply separately. Similarly, beneficiaries who receive Supplemental Security Income (SSI) or have a Medicare Savings Program may also automatically qualify.
How Much Can You Save on Prescription Drug Costs?
The amount of savings you’ll experience depends on whether you qualify for full or partial Extra Help. Here’s an overview of the potential benefits:
- Full Extra Help
- Pay no monthly premium if enrolled in a benchmark Part D plan.
- Reduced or no annual deductible costs.
- Prescription copayments as low as $0 for generic drugs and $9.85 for brand-name drugs (as of 2023).
- No coverage gap or “donut hole.”
- Partial Extra Help
- Reduced monthly premiums.
- A lower annual deductible cap for your Part D plan.
- Discounted copayments and other cost-sharing reductions.
These savings collectively ensure that eligible individuals spend significantly less on necessary medications, meaning you can better allocate your budget to other important expenses.
Step-by-Step Guide to Applying for Extra Help
Applying for Extra Help doesn’t have to be difficult. Here’s a simple step-by-step guide to help you get started:
- Gather Your Documents
Collect necessary information such as your Social Security number, income details, and current statements of savings or investments. - Submit an Application
Apply online through the Social Security Administration (SSA) website or by calling their helpline at 1-800-772-1213. You can also request a paper application if you prefer. - Wait for Notification
After submitting your application, the SSA will review your information to determine your eligibility. You’ll receive a notification in the mail regarding whether you qualify. - Choose a Medicare Part D Plan
If you’re approved for Extra Help, select a Medicare Part D plan that fits your prescription needs. The program may automatically enroll you in a plan, but you’re allowed to switch to one that better suits your preferences. - Reapply if Necessary
Remember that eligibility is reviewed periodically. You may need to reapply or update your details if your financial situation changes.
Where to Get Personalized Assistance With Your Application
While the Extra Help program provides incredible financial relief, navigating the process or dealing with Medicare can sometimes feel daunting. Fortunately, there are resources to guide you through every step. For California residents, organizations like HICAP (Health Insurance Counseling and Advocacy Program) offer personalized Medicare counseling for free. You can also reach out to the Social Security Administration (SSA) or Medicare directly for assistance.
Additionally, professional insurance agencies like Mint Insurance Agency specialize in helping clients understand their options for Medicare and Medicare-related programs. Working with an experienced agent ensures your application process is smooth and gives you peace of mind that you’re receiving all available benefits.
Need Help Making Sense of Medicare Advantage? Mint Insurance Agency Is Here to Help.
We are an insurance agency dedicated to becoming a lifetime partner for your Medicare and health coverage needs. If you need assistance or want to learn more about the alternatives available to you, contact our licensed agents today or call 1.888.225.MINT (6468). Our team is ready to answer all your questions and help you make the right decision for your circumstances.