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Medicare's Extra Help Program

Qualification Guidelines For Medicare's 
Extra Help Program. 

Article By : Patrick Mansfield | U.S. Gov Connect
Medicare Extra Help

Medicare Extra Help is a program that helps seniors (who qualify) with payments for Medicare Part D prescription Medicare plans. For those who qualify, Extra Help can make a difference in paying for prescription drugs. It’s estimated to add approximately $4,000 in savings per year.

Anyone insured by Medicare can get prescription coverage with Medicare Part D. However, some people with very limited financial resources may also get Extra Help to pay for these costs, including prescription co-pays, premiums, and annual deductible amounts related to their Medicare Part D. 

Qualifying for Extra Help:
  • The insured must be a U.S. resident (live in any of the 50 states or the District of Columbia)
  • His or her resources must be no more than $13,640 for a single person or $27,250 for a cohabiting married couple. Extra Help considers financial assets (stocks, bonds, etc.) and money in the bank as resources. The program doesn't consider the value of a Home, vehicle, or any Life Insurance policy(s).
  • Annual income limits are $17,655 for a single person or $23,895 for married couples. 
  • There are some scenarios in which the insured(s) can earn more money and qualify. If you and a cohabiting spouse: (1) Support other members of the family who live with you; (2) Live in Alaska or Hawaii (where the cost of living is higher); and (3) earn money from a job, Extra Help may be available.

Applying for Extra Help:

  • Call Social Security at +1-800-772-1213 (TTY +1-800-325-0778). If you need help in completing the application, someone will assist you.
  •  Visit a nearby SSA office.
  • Ask for a copy of the Extra Help application by mail. Complete and return to the form to SSA.
  • Complete the Social Security application for the Extra Help program (“Application for Extra Help with Medicare Prescription Drug Plan Costs, SSA-1020) online (www.socialsecurity.gov/extrahelp).

Making an online application is the secure method of choice. Applicants are guided through the application process. Each step tells you what information is needed to complete it. Apply from home or anywhere:
  • If you need to take a break, the application form saves the information you've supplied. If you need to make a change later, just log in and update. 
  • When you’re finished, apply directly from the computer.

What Happens Next

Social Security reviews the application and advises about whether you qualify. If you do, proceed with your choice of Medicare prescription plan. As soon as you choose a plan, you will begin to receive benefits. Otherwise, the Centers for Medicare & Medicaid (CMS) will decide for you.

Medicare Savings Programs

After you’ve completed the Extra Help application, begin an application for any of the Medicare Savings Programs. These state plans help members to defray other Medicare expenses. 
  • Social Security automatically sends your information to the state unless you ask them not to do so on the application. The state then contacts you about applying for one of the Medicare Savings Programs.
  • Like the Extra Help Medicare Part D Assistance program, these Medicare Savings Programs help people with limited financial resources to pay for Medicare Part B medical insurance premium costs. Some people may also receive financial assistance for Medicare Part A hospital insurance premium expenses, as well as Parts A and B co-pays and deductibles.

Not Everyone Receives Extra Help

If you don’t qualify for Extra Help, there may be additional enrollment options for your prescription drug plan. Visit www.medicare.gov to learn more about enrollment periods or contact CMS at +1-800-MEDICARE (+1-800-633-4227) or TTY +1-877-486-2048 to ask about the range of possibilities. 

Your State Health Insurance Counseling & Assistance Program (SHIP) is another useful resource. Call them with questions about Medicare questions if you prefer.
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