What is Extra Help for Medicare Part D?

Extra Help for Medicare Part D is a program to help people with limited income and resources pay Medicare prescription drug costs. For example, the Medicare Extra Help can help pay your Medicare Part D premiums, deductibles, and copayment costs. To join the low-income subsidy Extra Help program for Medicare Part D, you must have Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). However, you must have both Part A and Part B to join a Medicare Advantage plan. Now that you know Extra Help pays for your prescription drug costs, how do you qualify?

Extra Help Medicare Part D

Do I Qualify for Extra Help?

According to SSA.gov, to qualify for Medicare Extra Help for prescription drugs, you must be receiving Medicare and have limited resources and income. Furthermore, you must reside in one of the 50 States or the District of Columbia. Extra Help is not available in Puerto Rico, U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. Next, discover if you automatically qualify for Extra Help.

Do You Automatically Qualify For Extra Help?

You automatically qualify for Extra Help if you have any one of the following: 

  • Supplemental Security Income (SSI) and Medicare
  • Medicaid and Medicare
  • Medicare Savings Program


If you meet any of the above conditions, Medicare will send you a PURPLE notice. We advise you to keep this “Deemed Status Notice.” You do not need to apply for Extra Help. Then provide your Medicare Part D plan this document. It proves you qualify for Extra Help.

apply for medicare senior man on tablet

Furthermore, you can provide Medicare Part D with the following documents as proof that you qualify for Extra Help:

  • A yellow or green automatic enrollment notice from Medicare
  • Extra Help “Notice of Award” from Social Security
  • An orange notice from Medicare that says your copayment amount will change next year
  • Your award letter from Social Security that you have SSI

Extra Help Income and Resource Qualifications

As of February 2021, SSA.org published Understanding the Extra Help With Your Medicare Prescription Drug PlanIt states your resources and income must be limited to $14,790 for an individual or $29,520 for a married couple living together. Resources include things of value that you own, which may include the following:

  • Real estate (other than your primary residence)
  • Bank accounts
  • Stocks
  • Bonds
  • Mutual Funds
  • IRAs
  • Cash

 

On the other hand, resources that do not count include the following:

  • Your primary residence
  • Personal possessions such as jewelry or home furnishings
  • Your vehicle
  • Property you need for self-support, such as rental property or land you use to grow produce for home consumption
  • Non-business property essential to your self-support
  • Life insurance polices
  • Burial expenses

Benefits of Extra Help

The amount of Extra Help you receive depends on your income and resources. You can receive either a full-subsidy or a partial low-income subsidy for Part D. Anyone who meets State Medicaid financial eligibility qualifies for Full Low-Income (LIS) Subsidy and pays no premiums, no deductible, no copay, and no coinsurance. Furthermore, anyone who qualifies for Full LIS will pay no more than $8.95 copay for brand-name and $3.60 copay for generic drugs.

In addition to lower out-of-pocket expenses, Medicare beneficiaries with Extra Help have three Special Enrollment Periods. You can join or switch Medicare Part D drug plans every three months from January through September. Furthermore, you can join or switch during the Annual Enrollment Period (Oct 15 – Dec 7). Moreover, you do not pay Part D late enrollment penalties.

Extra Help Medicare Part D

How to Apply Medicare Part D Extra Help?

You can apply for Extra Help online. To complete the application, you will need to provide SSA.gov information about your income and resources. Documents that can help you include the following:

  • Social Security card
  • Bank account statements
  • Individual Retirement Acounts, stocks, bonds, mutual funds
  • Tax returns
  • Payroll slips
  • Your most recent Social Security benefits award letters or statements for Railroad Retirement benefits, Veterans Benefits, pensions and annuities

 

Apply for Extra Help at Social Security Administration website.

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