If you have a limited income or resources, you may qualify for Extra Help from Medicare to cover your Medicare prescription drug coverage. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles and coinsurance.
If you qualify for this federally-funded program, you may be protected from the coverage gap and late enrollment penalties as well.
Many people are eligible for these savings and don’t even know it. To start, you must be enrolled in a Part D prescription drug program, either as a stand-alone plan, or as part of a Medicare Advantage plan. You must also live in one of the 50 states and meet certain income and resources criteria. If you have Medicare and Supplemental Security Income (SSI) or Medicare and Medicaid, you will automatically get the Extra Help.
For more information about this Extra Help program, contact your local Social Security office or call 1-800- MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048. You can also apply through Social Security online.
There are four levels of Extra Help.
In most cases, your financial circumstances will determine whether you’re eligible and the level of support you will receive — a full 100% subsidy, 75%, 50% or 25%. Once enrolled, this subsidy will be applied to your monthly stand-alone Part D or Medicare Advantage Part D premium. You’ll also be charged lower copayments at the pharmacy. The following table shows what your premium will cost for a qualifying plan at each of the four support levels.
The below premiums do not include the Medicare Part B premium you may still have to pay.
Do not skip your medicine because of costs
To find out more about the Extra Help program and see if you qualify:
— Call 1-800-MEDICARE (1-800-633-4227)
TTY users should call 1-877-486-2048
24 hours a day/7 days a week
— Contact Social Security Administration at 1-800-772-1213,
7 a.m. - 7 p.m., Monday through Friday
TTY users should call 1-800-325-0778
— Contact your state Medicaid office
To determine if you are eligible, or to recertify your low-income subsidy status with the federal government, go to Extra Help With Medicare Prescription Drug Plan Costs.
If you believe you qualify for a low-income subsidy and you believe you are paying an incorrect copayment amount, Medicare has established a process that will allow you to provide evidence to support your proper copayment level. Please visit the Centers for Medicare & Medicaid Services to view the Best Available Evidence Policy.