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How Do You Qualify For Extra Medicare Benefits

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How to Lower Medicare Part D Costs with Extra Help
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Medicare’s Comprehensive Prescription Drug Coverage Benefit

Part D is Medicares comprehensive prescription drug coverage benefit and is available to anyone eligible for Medicare Part A or Part B. People with Medicare may enroll in Part D coverage through either a stand-alone plan or a Medicare Advantage plan. People on Medicare who choose not to enroll and have no other drug coverage may pay more for late enrollment.

How Do You Enroll In The Medicare Qmb Program

To enroll in the QMB program, you first need to be enrolled in Medicare Part A.

The next step is to review your income and assets to see if you fall below the limits set by Medicare. But remember there are exceptions to those limits, and youre encouraged to apply even if your income or assets exceed them.

To apply for the QMB program, youll need to contact your state Medicaid office. You can check online to find your states office locations, or call Medicare at 800-MEDICARE. The documentation youll need varies by state, but your application process will likely include submissions of identification, proof of Medicare coverage, and financial information.

Once you submit your application, you should receive a confirmation or denial within about 45 days. If youre denied, you can request an appeal. Enrollment in any of the MSPs must be renewed each year.

Even when your QMB is active, you may at times be wrongfully billed for items or services that it covers. Contact Medicare for any billing problems. Be sure to carry documentation of your participation in the QMB program and show it to your providers.

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Whos Eligible For The Medicare Qmb Program

Since the QMB program aims to help individuals with low income, it places limits on the monthly income and financial resources available to you. If you exceed these limits, you may not be eligible for the program.

Generally, participation is limited to individuals who meet the federal poverty level. For 2021, the federal poverty level is $12,880 per year for individuals in Washington, D.C., and 48 states. Limits are higher in Alaska and Hawaii .

Specific financial requirements for the QMB for individuals are:

  • a monthly income limit of $1,094
  • an asset limit of $7,970

Specific financial requirements for the QMB for are:

  • a monthly income limit of $1,472
  • an asset limit of $11,960

If you think your income and assets are too high to make you eligible for this program, try applying anyway. Several exceptions and considerations are made when calculating income and assets.

Income that isnt counted toward QMB eligibility includes:

  • the first $20 of your income for the month
  • the first $65 of any wages you earn for the month
  • half of any wages you earn after the initial $65 is deducted

The program does allow you to have $20 in income each month above the federal poverty limit.

Income limits may also vary slightly by state. You must be a resident of the state in which youre applying for the QMB program, and you must already be enrolled in Medicare Part A.

Assets that arent counted when you apply for the QMB program include:

Who Is Eligible For Medicare

Steps to Signing up for a Nevada Medicare Plan

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease . Medicare has two parts, Part A and Part B . You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

  • You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
  • You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
  • You or your spouse had Medicare-covered government employment.

To find out if you are eligible and your expected premium, go the Medicare.gov eligibility tool.

If you did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

  • You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months.
  • You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

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Who Qualifies For Extra Help

You must have both limited income and limited resources to qualify for the Extra Help program.

In 2022, your annual income cant exceed $15,510 for an individual or $30,950 for a married couple living together. This includes Social Security and pension payments.

However, not all cash payments count as income. For example, money from the Supplemental Nutrition Assistance Program , earned income tax credit payments and educational grants dont count toward the limit.

Other forms of assistance including housing assistance, home energy assistance, disaster relief and assistance from others who help you pay your household bills also dont count as income.

To qualify for Extra Help, your resources cant exceed $15,510 for an individual or $30,950 for a married couple living together.

Resources include:

  • Bank accounts, including checking, savings and certificates of deposit
  • Investments, including stocks, bonds and mutual funds.
  • Individual Retirement Accounts

Several resources dont count toward the Extra Help limit, and therefore wont impact your eligibility.

Resources that dont count include:

$3.95 copay for generic drugs and $9.85 copay for brand-name drugs

  • No copay after $7,050 in out-of-pocket drug costs

If youre dual-eligible for both Medicare and Medicaid or youre enrolled in a Medicare Savings Program, you automatically qualify for full Extra Help benefits.

Medicare Extra Help For Low Income Persons

For individuals who receive Part D prescription drug coverage and are low-income, there is assistance available for the costs of deductibles and co-pays. This Extra Help is also known as the Low Income Subsidy .

Who is eligible?To receive Extra Help, persons must be eligible for Medicare Part D and have income less than 100% of the Federal Poverty Level for a full benefit or less than 150% of the Poverty Level for a partial benefit.

What are the benefits?Benefits vary based on the recipients income and on living situation. In general, Extra Help will pay for a persons monthly drug plan premium for an Extra Help approved plan. It will also pay the annual deductible amount , though it will leave $99 deductible for partial subsidy recipients to pay out of pocket. Extra Help will also cover all drugs in the coverage gap, or doughnut hole, or 85% of drug costs for partial subsidy recipients. Individuals will pay $3.95/generic or multi-source drug and $9.85 for other drugs.

In the standard benefit, when Medicare beneficiaries have spent $4,430 in 2022 in prescription costs, the coverage gap begins however, individuals who are receiving Extra Help will continue to pay co-payments between $3.95 for generic or multisource drugs with a retail price under $79 and 5% for those with a retail price greater than $79. For brand-name drugs, beneficiaries would pay $9.85 for those drugs with a retail price under $197 and 5% for those with a retail price over $197.

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What Are The Extra Medicare Benefits

Get a Medicare Advantage Plan: A Medicare Advantage Plan is an all-in-one alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. Most plans offer extra benefitslike vision, hearing, dental, and more. Now, if you have ESRD, you can enroll in a Medicare Advantage Plan.Nov 6, 2020

What Are The Benefits Of Extra Help And Epic

How To Apply For Medicare Online – Step By Step

Those approved for full Extra Help, a Medicare Savings Program or a Medicaid Spenddown do not have to pay any EPIC fees. EPIC will continue to pay Medicare Part D plan premiums for LIS members, and those with Full LIS in enhanced plans or Medicare Advantage plans up to the basic amount after Medicare premium subsidization.

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How To Apply For Extra Help With Medicare

To apply for Extra Help, you can fill out Form SSA-1020 on the Social Security website. You can also call Social Security to apply over the phone or visit your local Social Security office to apply in person.

Social Security will mail a letter to you, informing you of whether you qualify for Extra Help. You can choose a Part D prescription drug plan after you qualify for Extra Help. If you havent qualified, you can still look for a Part D plan that fits your budget and includes your prescriptions in the formulary.

How To Apply For Medicare Extra Help

Lots of Medicare enrollees are eligible for Extra Help, but many dont know about the program or dont apply.

There are three ways to apply for the Extra Help program:

  • Use the online application on the Social Security Administration website.
  • Apply in person at your local Social Security office.

If you are approved for Extra Help, there is one more step: choosing a prescription drug plan if you dont already have one. If you dont choose a plan, Medicare will assign one to you randomly. Choosing your own drug plan allows you to get coverage sooner.

For help choosing a plan, check out our Guide to Medicare Part D.

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Finding Help With Prescriptions Guide

“Finding Help with Prescriptions” Guide is a free publication. It provides helpful information for lowering your prescription costs including low-income assistance, patient assistance programs, mail order prescription services, veterans pharmacy benefits, and Community Health Centers.

To request a copy, call SHIP free of charge 452-4800 or email


Medicares Extra Help Program


Get Extra Help Paying Your Medicare Drug Costs

Extra Help is a Medicare program to help people with limited income and resources pay for their Medicare prescription drug coverage, such as plan premiums, deductibles, copays or coinsurance. Additionally, those who qualify will not have a coverage gap or late enrollment penalty.

Qualifying for Extra Help

To qualify for Extra Help, you must have Medicare and have limited income and resources. You must also reside in one of the fifty states or the District of Columbia. You may automatically qualify for Extra Help If you have Medicare and meet any of these conditions:

  • You have full Medicaid coverage
  • You get help from your state Medicaid program paying your Part B premiums
  • You get Supplemental Security Income benefits

If you have automatically qualified for Extra Help, youll receive a purple letter in the mail from Medicare. Its important to keep this letter for your records.

Applying for Extra Help

If you didnt automatically qualify for Extra Help, you can apply at any time. Youll need to complete Social Securitys application for the Medicare Extra Help program in one of the following ways.

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Find Your Level Of Extra Help

Extra Help is a program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. If you get Extra Help but youre not sure if youre paying the right amount, call your drug plan. Your plan may ask you to give information to help them check the level of Extra Help you should get.

When Do You Get A Notice From Medicare

Just because you qualify one year does not mean you will qualify the next. Youll receive a notice from Medicare around the end of September if the SSA believes you no longer automatically qualify for Extra Help. In this case, you will need to reapply for the program through SSA.gov or your local Medicaid office.

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If You Qualify For Extra Help

Well automatically enroll you in a Medicare drug plan , if you dont have one already. We do this so you can get the cost savings you qualify for.

  • Youll get a letter telling you:
  • About your new plan. You can pick a different Medicare drug plan if you want.
  • What youll pay, depending on the level of Extra Help you get.
  • That you get Extra Help for the rest of the calendar year. Even if your income changes in the middle of the year, youll keep getting Extra Help through December 31.
  • If you meet the income and resource limits for next year,youll keep getting Extra Help. Well mail you a letter only if:
  • Your Extra Help changes.
  • You no longer qualify for Extra Help.
  • You get moved to a different plan for next year.
  • If you dont get a letter from Medicare or Social Security, youll keep the same level of Extra Help and same plan for next year.
  • Extra Help Level:

    you can reapply for Extra Help any time

    What Are The Income Limits For Medicare 2021

    Medicare Part B Give Back Benefit – What’s The Catch?

    In 2021, the adjustments will kick in for individuals with modified adjusted gross income above $88,000 for married couples who file a joint tax return, that amount is $176,000. For Part D prescription drug coverage, the additional amounts range from $12.30 to $77.10 with the same income thresholds applied.Nov 10, 2020

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    Can I Get Extra Benefits With Medicare Advantage


    Want prescription drug coverage? Fitness benefits? A ride to the doctor office? A Medicare Advantage Plan may offer all that and more as extra benefits. Medicare Advantage plans sometimes provide extra benefits including things like prescription drug coverage, dental care, routine vision, and routine hearing, among others. Medicare Advantage plans are offered by private insurance companies approved by the Centers for Medicare & Medicaid Services . Medicare Advantage plans offer all the coverage that Original Medicare offers and also may offer many extra benefits as well.

    What Is Extra Help

    Extra Help is not insurance itself. It is a subsidy that lowers the cost of your drug coverage in Medicare Part D. With Extra Help, you will get the same coverage as anyone on the same plan, but you will pay less for it. The Extra Help program is sometimes called the Part D Low-Income Subsidy program.

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    How Much Medicare Extra Help Can Save You

    Even if you qualify for Medicare Extra Help, your income level, resource level, marital status, and Medicaid eligibility will determine whether you qualify for full or partial Extra Help.

    Medicare Extra Help can be understood in relation to Medicare Part D. If you qualify for Extra Help, then it reduces your Part D out-of-pocket costs. In certain circumstances, you’ll pay $0 in Part D premiums and deductibles and heavily reduced copays for prescriptions. The table below explains how Extra Help reduces Part D costs.

    If you qualify for both Medicaid and Medicare Extra Help, and are receiving care in an institution, such as an assisted living facility, nursing home, or rehabilitation hospital, or from certain home and community health services, then Extra Help may reduce your Part D costs to nothing.

    What Is The Medicare Extra Help Program

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    Extra Help is a prescription drug savings program for Medicare beneficiaries with limited income and resources.

    This program, also known as the Part D Low Income Subsidy, is administered by the Social Security Administration and the U.S. Centers for Medicare & Medicaid Services.

    The amount you can save on your Medicare costs depends on your income and resources.

    You can receive either a full subsidy or a partial subsidy.

    Most people who qualify for Extra Help pay:

    • $0 premiums for drug coverage.
    • $0 plan deductibles .
    • No more than $9.85 in 2022 for each prescription your plan covers.

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