What is Medicare Extra Help?

Medicare Extra Help is a federal assistance program, administered by the Social Security Administration, that helps individuals with limited income and resources pay for Medicare prescription drug costs (Medicare Part D).  If you qualify for Medicare Extra Help, also known as Low-Income Subsidy (LIS), you will receive assistance towards part D premiums, annual deductibles, and prescription drug co-payments.

Eligibility

You will automatically qualify if you currently receive Medicare and also meet the following requirements: 

• You receive Medicaid
• You are enrolled in a Medicare savings program
• You receive Supplemental Security Income (SSI) benefits

The program is also available through income and asset eligibility regardless of the above requirements.  For 2020, an individual may qualify for the program if their annual income is at or below $19,140 and their assets do not exceed $14,610.  For a married couple, the income threshold is $25,860 while the asset threshold is $29,160.

According to ssa.gov assets include the value of things you own such as:

• Real Estate (not including your primary residence)
• Bank accounts including checking, savings, certificates of deposit
• Stocks
• Bonds
• Mutual Funds
• Individual Retirement Accounts (IRA)
• Cash at home or anywhere else

Benefits

The amount of assistance you receive through the program varies depending on your income.  In general, the benefits include:

• Full or partial payment of Part D premium, yearly deductible, coinsurance, and copayments
• Lower prescription drug costs
• Special Enrollment Period
• No coverage gap
• No late enrollment penalty

How to Apply 

If you automatically qualify for Medicare Extra Help because you currently receive Medicaid, are enrolled in a Medicare savings plan, or you receive SSI benefits you do not need to apply.  You will automatically be enrolled in the program.

If you are applying based on income and asset eligibility you will need to fill out an application.  You can fill out the Medicare Extra Help application online at ssa.gov or you can apply in person at your local office. You may also apply via phone or mail. For more information visit the Social Security Administration website.

How Extra Help Works

Once you are approved, you will receive an eligibility notice from Medicare.  Provide the eligibility notice or other documentation such as Medicaid card to the insurer to start receiving lower prescription drug costs.  Depending on your level of eligibility your out of pocket costs will also be heavily reduced and in some cases eliminated completely.  It is important to remember income and asset eligibility change each year so even though you qualify one year, you may not qualify the next.