What Is Medicare Extra Help?

June 30, 2020

Prescription drug coverage is important for anyone who is eligible for Medicare. But the cost of this coverage stops many people from getting it. 

The Extra Help program can help you pay for your Medicare prescription drug costs. In this article you’ll learn what Extra Help specifically covers and find out if you qualify for this program.

What is Medicare Extra Help?

Extra Help is not insurance itself. It is a subsidy that lowers the cost of your drug coverage in Medicare Part D. With Extra Help, you will get the same coverage as anyone on the same plan, but you will pay less for it.

The Extra Help program is sometimes called the Part D Low-Income Subsidy (LIS) program. That’s because it was created for people with limited financial resources.

People with low incomes may have trouble paying for the many costs of Medicare drug coverage:

  • Monthly premiums
  • Annual deductibles
  • Copayments when you pick up a prescription
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What does Extra Help cover?

Depending on your situation, Extra Help will cover a portion of your drug costs or all of your drug costs.1 This assistance can save you as much as $5,000 a year.2

The Extra Help program only covers costs related to a Medicare prescription drug plan (Part D). It does not help with costs from other parts of Medicare (Part A, Part B, Part C, or Medicare supplement plans). 

If you need a refresher on the parts of Medicare, see our Medicare 101 Guide

Extra Help also eliminates the late-enrollment penalty for not getting Part D drug coverage when you were first eligible. However, it doesn’t affect the Part B late-enrollment penalty.

Medicare costs
Covered by Extra Help?
Part A premiums, deductibles, coinsurance No
Part B premiums, deductibles, coinsurance No
Part B late-enrollment penalty No
Part C (Medicare Advantage) premiums, deductibles, coinsurance No
Part D premiums, deductibles, coinsurance, prescription copayments Yes
Part D late-enrollment penalty Yes (penalty is waived)
Medicare supplement (Medigap) plans No

Do I qualify for Extra Help with Medicare?

You can qualify for the Extra Help program if both of these are true:

  • Your income is $19,140 a year or less. Common examples of income are wages, pensions, and Social Security benefits. If you’re married, your spouse’s income is counted, too, and the income limit goes up to $25,860. 
  • You have $14,610 or less in resources. Your resources are the things you own and how much they are worth. Common examples are your bank accounts, retirement accounts (IRAs, 401(k)s), and any cash you have. Your home and vehicle are not counted. If you’re married, the resource limit for Extra Help is $29,160. 

Even if your income and resources are above these limits, you can still apply for the Extra Help program, because you might qualify for partial assistance. You may also be able to receive Extra Help if you meet one of these exceptions:

  • You are supporting other family members in your household. 
  • You live in Alaska or Hawaii. (These states have higher income limits.) 
  • You are an American Indian or Alaska Native. ​
Some people get Extra Help automatically

If you have Medicaid or Supplemental Security Income (SSI), you are automatically included in the Extra Help program.

How to apply for Medicare Extra Help

Lots of Medicare enrollees are eligible for Extra Help, but many don’t know about the program or don’t apply. 

There are three ways to apply for the Extra Help program:

  • Use the online application on the Social Security Administration (SSA) website.
  • Call Social Security at +1-800-772-1213 (TTY +1-800-325-0778) to apply by phone or request a paper application.
  • Apply in person at your local Social Security office. (Note: This option is currently unavailable because Social Security offices are closed due to the COVID-19 pandemic.) 

If you are approved for Extra Help, there is one more step: choosing a prescription drug plan if you don’t already have one. If you don’t choose a plan, Medicare will assign one to you randomly. Choosing your own drug plan allows you to get coverage sooner.

For help choosing a plan, check out our Guide to Medicare Part D.

The bottom line

The Extra Help program can lower your Medicare Part D prescription drugs costs. It may save you as much as $5,000 per year. To qualify, you must have income and resources below set limits. Some people are automatically enrolled in Extra Help, and others can apply to get their drug costs lowered.

FAQ

What is the income limit for Medicare Extra Help in 2020?

The income limit is $19,140 for individuals or $25,860 for married couples living together.

Does Extra Help pay for the Part B premium?

No. The Extra Help program is just for costs related to Medicare prescription drug plans (Part D). Other parts of Medicare, such as Part B, are not included in the subsidy.

Can I get help with Medicare costs not covered by Extra Help?

Yes. You can get help from your state. State-run Medicare Savings Programs can help with costs from other parts of Medicare. When you apply for Extra Help, the Social Security Administration will share your information with your state. Your state will then contact you to apply for its programs.

How long can I stay on Extra Help?

You can remain on the program for as long as you qualify. When you are on the Extra Help program, your status will be reviewed each year, usually in August.

Can both my spouse and I apply for Extra Help?

Yes. If you are both on Medicare (or will be in the next three months), you can apply for Extra Help on the same application.

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Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.

Written by
Kathryn Anne Stewart
Kathryn Anne Stewart is a freelance writer who covers the intersection of health and money. She has written for Johns Hopkins Medicine, Weight Watchers, Newsmax Magazine, Franklin Prosperity Report, and the National Hemophilia Foundation, often crafting clear explanations of complex topics. When she's away from her desk, you can find her reading a library book, watching stand-up comedy, or cycling with her husband.
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