Ssa.gov/benefits/medicare Extra Help

How To Apply Online For Just Medicare

Are you within three months of turning age 65 or older and not ready to start your monthly Social Security benefits yet? You can use our online retirement application to sign up just for Medicare and wait to apply for your retirement or spouses benefits later. It takes less than 10 minutes, and there are no forms to sign and usually no documentation is required.

To find out what documents and information you need to apply, go to the .

Medicare Savings Programs To Help Pay For Medicare Health Care Costs

You can get help from your state paying your Medicare premiums. In some cases, Medicare Savings Programs may also pay Medicare Part A and Medicare Part B deductibles, coinsurance, and copayments if you meet certain conditions. There are four kinds of Medicare Savings Programs:

• Qualified Medicare Beneficiary Program – helps pay for Part A and/or Part B premiums, and in addition Medicare providers aren’t allowed to bill you for services and items Medicare covers like deductibles, coinsurance, and copayments.
• Specified Low-Income Medicare Beneficiary Program – helps pay for Part B premiums.
• Qualified Individual Program – helps pay for Part B premiums and funding for this program is limited.
• Qualified Disabled and Working Individuals Program – helps pay for Part A premiums only.

If you qualify for a QMB, SLMB, or QI program, you automatically qualify to get Extra Help paying for Medicare prescription drug coverage.

What Does Extra Help Cover

Depending on your situation, Extra Help will cover a portion of your drug costs or all of your drug costs.1 This assistance can save you as much as $5,000 a year.2

The Extra Help program only covers costs related to a Medicare prescription drug plan . It does not help with costs from other parts of Medicare .

If you need a refresher on the parts of Medicare, see our Medicare 101 Guide.

Extra Help also eliminates the late-enrollment penalty for not getting Part D drug coverage when you were first eligible. However, it doesnt affect the Part B late-enrollment penalty.

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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.

you can reapply for Extra Help any time

What Does Medicare Extra Help Cover

The Extra Help program can save you up to $5,000 each year. Many people qualify for this savings but dont know it.If you qualify for the Extra Help program, you will get help paying for Medicare prescription drug costs that is a part of your Part D coverage such as your monthly premium, yearly deductible, prescription co-payments and coinsurance. This Extra Help also counts toward your out-of-pocket costs.

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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.

Who Gets Extra Help Automatically

You’ll get Extra Help automatically if you get:

• Full Medicaid coverage
• Supplemental Security Income benefits from Social Security

You’ll get a letter about your Extra Help. It tells you things like how much you’ll pay, and your new Medicare drug plan, if you don’t have one already.

If you dont automatically get Extra Help, you can apply for it:

Or call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

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Monthly Medicare Premiums For 2022

The standard Part B premium for 2022 is $170.10. If youre single and filed an individual tax return, or married and filed a joint tax return, the following chart applies to you:

What Is Medicare Extra Help

Prescription drug coverage is important for anyone who is eligible for Medicare. But the cost of this coverage stops many people from getting it.

The Extra Help program can help you pay for your Medicare prescription drug costs. In this article youll learn what Extra Help specifically covers and find out if you qualify for this program.

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See If You Qualify For Extra Help

Some people automatically qualify for the Extra Help program and don’t need to apply. Medicare will mail you a letter if you automatically qualify for Extra Help.Your income and resources can change from year to year, so check to see if you qualify for the program if you didnt receive a letter from Medicare or were previously denied for the Extra Help program.

What Does Medicaid Cover

• If you have Medicare and full Medicaid coverage, most of your health care costs are covered. You can get your Medicare coverage through Original Medicare or a Medicare Advantage Plan.
• If you have Medicare and/or full Medicaid coverage, Medicare covers your Part D prescription drugs. Medicaid may still cover some drugs that Medicare doesnt cover.
• People with Medicaid may get coverage for services that Medicare doesnt cover or only partially covers, like nursing home care, personal care, transportation to medical services, home- and community-based services, anddental, vision, and hearing services.

PACE is a Medicare and Medicaid program offered in many states that allows people who otherwise need a nursing home-level of care to remain in the community. To qualify for PACE, you must meet these conditions:

• Youre 55 or older.
• You live in the service area of a PACE organization.
• Youre certified by your state as needing a nursing home-level of care.
• At the time you join, youre able to live safely in the community with the help of PACE services.

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Where Can I Find More Information

To find more information about Maryland programs for seniors, visit www.aging.maryland.gov. You can also call 410-767-1100, 800-243-3425 , or 410-767-1083 . The Centers for Medicare and Medicaid Services offer consumer resources at www.medicare.gov and 1-800-MEDICARE. The Social Security Administration has several helpful publications on its website, visit .

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.

• : call Social Security at 1-800-772-1213
• Online: Complete an application using Social Securitys Online Application Form

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How Do I Apply For Medicare Benefits

If you are already receiving Social Security retirement or disability benefits or railroad retirement checks, Social Security will contact you a few months before you become eligible for Medicare and give you the information you need to register. You should sign up for Medicare even if you dont plan to retire at age 65, or you may be penalized a 10% premium surcharge for each year past age 65 that you do not have Medicare. However, if you are age 65 or older and are covered under a group health plan either from your own employment or you are covered from your spouses employment, you may delay enrolling in Medicare medical insurance without having to wait for a general enrollment period or pay the 10% premium surcharge for late employment. The rules allow you to:

• Enroll in Part B any time you are covered under the group health plan, or
• Enroll in Part B during an eight-month special enrollment period that begins with the month your group health coverage ends or the month your employment ends, whichever comes first

I disagree with the SSAs decision on my claim. How can I appeal? Please visit www.ssa.gov/pubs/10041.html or call 1-800-772-1213 to file an appeal. All appeals should be sent to your local office to find your local office, please visit www.ssa.gov/locator.

The Parts Of Medicare

Social Security enrolls you in Original Medicare .

• Medicare Part A helps pay for inpatient care in a hospital or limited time at a skilled nursing facility . Part A also pays for some home health care and hospice care.
• Medicare Part B helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.

Other parts of Medicare are run by private insurance companies that follow rules set by Medicare.

• Supplemental policies help pay Medicare out-of-pocket copayments, coinsurance, and deductible expenses.
• Medicare Advantage Plan includes all benefits and services covered under Part A and Part B prescription drugs and additional benefits such as vision, hearing, and dental bundled together in one plan.
• Medicare Part D helps cover the cost of prescription drugs.

Most people age 65 or older are eligible for free Medicare hospital insurance if they have worked and paid Medicare taxes long enough. You can sign up for Medicare medical insurance by paying a monthly premium. Some beneficiaries with higher incomes will pay a higher monthly Part B premium. To learn more, read .

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Do You Think You’re Paying The Wrong Amount For Your Prescription

If you qualify for Extra Help and think youre paying the wrong amount, heres what you can do:

• Contact your drug plan. Your plan may ask for proof that you get Extra Help so they can correct your costs. Examples of proof you get Extra Help.

You may be able to get some money back if you:

• Paid for prescriptions after you qualified for Extra Help
• Arent in a Medicare drug plan

Keep your receipts with your prescription drug prices, and call Medicare’s Limited Income Newly Eligible Transition Program at1-800-783-1307. TTY users can call 711.

Supplemental Security Income Benefits

SSI is a cash benefit paid by Social Security to people with limited income and resources who are blind, 65 or older, or have a disability. SSI benefits arent the same as Social Security retirement benefits. You may be able to get both SSI benefits and Social Security benefits at the same time if your Social Security benefit is less than the SSI benefit amount, due to a limited work history, a history of low-wage work, or both. If youre eligible for SSI, you automatically qualify for Extra Help, and are usually eligible for Medicaid.

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How Do I Apply For Disability Benefits

To apply for disability benefits, please visit www.ssa.gov/applyfordisability. In order to be approved for disability benefits, you must prove the following:

• You are unable to perform work that you were able to do before, and your disability must be expected to last 12 months or result in death
• You cannot adjust to other work because of a medical condition

If you do receive disability benefits, they wont begin until the sixth full month after the date the SSA decides the disability began. In addition, you must wait two years before you qualify for Medicare coverage.

If You Disagree With Our Decision

If you disagree with the decision we made about your income-related monthly adjustment amounts, you have the right to appeal. The fastest and easiest way to file an appeal of your decision is online. You can file online and provide documents electronically to support your appeal. You can file an appeal online even if you live outside of the United States.

You may also request an appeal in writing by completing a Request for Reconsideration , or contact your local Social Security office. You can use the appeal form online, or request a copy through our toll-free number at 1-800-772-1213 . You dont need to file an appeal if youre requesting a new decision because you experienced one of the events listed and, it made your income go down, or if youve shown us the information we used is wrong.

If you disagree with the MAGI amount we received from the IRS, you must correct the information with the IRS. If we determine you must pay a higher amount for Medicare prescription drug coverage, and you dont have this coverage, you must call the Centers for Medicare & Medicaid Services to make a correction at 1-800-MEDICARE . We receive the information about your prescription drug coverage from CMS.

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Extra Help To Pay For Medicare Prescription Drug Costs

Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help if your yearly income and resources are below these limits in 2022:

• Single person – yearly income less than $20,388 and less than $14,010 in other resources per year

You may qualify even if you have a higher income . Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual RetirementAccounts . Resources dont include your home, car, household items, burial plot, up to $1,500 for burial expenses , or life insurance policies.

If you qualify for Extra Help and join a Medicare drug plan, you’ll:

• Get help paying your Medicare drug plan’s costs.
• Have no late enrollment penalty.

You automatically qualify and will receive 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.

Drug costs in 2022 for people who qualify for Extra Help will be no more than $3.95 for each generic drug and $9.85 for each brand-name drug.

Extra Help For Prescription Drug Coverage

Extra help for prescription drug coverage is available for people with Medicare who have limited income and resources. If eligible for extra help, Medicare will pay for almost all prescription drug costs. Extra help provides a subsidy based on the amount of income and resources a person has.

Full Subsidy Benefits from Extra Help:

• Full premium assistance up to the premium subsidy amount
• Nominal cost sharing up to out-of-pocket threshold
• No coverage gap

Other Low Income Subsidy Benefits from Extra Help:

• Sliding scale premium assistance
• Reduced coinsurance
• No coverage gap

An individual who has Medicare and Medicaid does not need to apply for extra help from Social Security. An individual who is eligible for the Medicare Savings Program does not need to apply for extra help from Social Security. The MSP-eligible individual’s information is sent to CMS automatically for the extra help.

Eligibility specialists ask, “Can I screen you for eligibility for Medicare Savings Program since certification would include eligibility for extra help?”

If the caller does not want to be screened for MSP, refer the caller to the Centralized Benefit Services, 1-800-248-1078, for completion of subsidy application.

If an individual thinks personal information is being misused, call 1-800-MEDICARE .

Apply for extra help or get more information about extra help subsidy by calling Social Security at 1-800-772-1213 or visiting www.socialsecurity.gov.

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Extra Help Paying For Medicare Prescription Drug Coverage

Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. You may qualify for Extra Help, also called the low-income subsidy if your yearly income and resources are below the following limits in 2022:

• Single personIncome less than $1,469 monthly and resources less than $9,900

These amounts may change each year. You may qualify even if you have a higher income . Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts . Resources dont include your home, car, household items, burial plot, up to $1,500 for burial expenses , or life insurance policies. If you qualify for Extra Help and join a Medicare drug plan, you will get the following:

• Help paying your Medicare drug plans monthly premium, yearly deductible, coinsurance, and copayments
• No coverage gap
• No late enrollment penalty
• You automatically qualify for Extra Help if you have Medicare and meet one 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