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What Is Medicare Extra Help & What Does It Cover?

Medicare Part D helps cover prescription drugs, but it doesn’t cover all of the costs. These out-of-pocket costs can quickly add up. Sometimes, the medications you need might be too expensive to afford. If this is the case, do not feel discouraged. You might qualify for Extra Help, a federal program that helps pay for some of these costs.

Who Is Eligible for Medicare Extra Help?

Depending on your monthly income, you may be eligible for the Medicare Extra Help program. In addition to income, your assets are also considered when you apply for Extra Help. You should still apply even if your monthly income and assets exceed the typical eligibility limits. You might still qualify. Complete the application if:

  • You have Medicare Parts A and B
  • Your combined savings and assets are not more than $18,735 if you are single or $25,365 if you are married

In some cases, you might automatically qualify for Extra Help. You might automatically qualify if you:

  • Have full Medicaid coverage
  • Get help from your state Medicaid program to pay your Part B premium
  • Get Supplemental Security Income benefits

It is important to note that your qualifications for Extra Help might change from year to year. If you do not qualify one year, you might the next. If you do qualify one year, you might not the next.

Extra Help Coverage

Not all Extra Help coverage is the same. Depending on your monthly income and your assets, you may qualify for full or partial Extra Help.  If you qualify for full Extra Help, then you will have a $0 premium and deductible. This premium is only free if you also have a basic Part D drug plan with a premium at or below the Extra Help premium limit for your area. Your copay for generic prescription medications will be $3.60 and your copay for brand-name prescription medications will be $8.95. Your copayments will stop after you reach $5,000 in out-of-pocket drug costs.

If you qualify for partial Extra Help, your premium will depend on your income. You will find out more information about this coverage when you apply for Extra Help. In addition to the premium, you will have to pay an $83 deductible or the plan’s standard deductible, whichever is less expensive. You will have to pay 15% coinsurance or the plan’s copay, whichever is cheaper. After you hit $5,000 in out-of-pocket drug costs, you will pay $3.60 for generic prescription drugs, $8.95 for brand-name prescription drugs, or 5% of the drug cost, whichever is greater.

What If I Don’t Qualify for Extra Help?

You still have some options even if you don’t qualify for Extra Help. Your state might have programs in place to help you pay for your medications. To find out if your state offers these programs, contact your local State Health Insurance Assistance Program for more information.

How Can I Apply for Extra Help?

You can apply for Extra Help by going to the Social Security Administration website. On this site, you can find out if you qualify, apply for Extra Help, or return to an existing application.

How GoMedigap Can Help

Extra Help provides complete coverage for your prescription drugs, but there are still gaps in your Medicare coverage. With a Medicare Supplement plan, you can be sure that all of your costs are covered. For example, if you have a doctor’s visit, certain Medigap plans will cover the cost of your copayment. If you qualify for Extra Help, the costs of any prescription drugs prescribed during that visit will change.

Understanding copayments and the costs associated with plans can be confusing, but don’t worry. We’re here to help.

Nothing on this website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

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