Ssa Gov Benefits Medicare Prescription Help

See If You Qualify For Extra Help

Some people automatically qualify for the Extra Help program and dont 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.

Extra Help With Your Medicare Prescription Drug Plan Costs

The Extra Help program assists people with limited resources and lower incomes in paying for Medicare Part D prescription drug coverage.

Receiving Extra Help with your Medicare Part D can:

• Eliminate the Medicare Part D late enrollment penalty
• Reduce your out-of-pocket costs for prescription drugs
• Eliminate your monthly Medicare Part D premiums
• Reduce or eliminate your annual Medicare Part D deductible
• Eliminate the coverage gap, also known as the donut hole

As Extra Help removes the donut hole, your prescriptions will not cost more when you exceed the annual spending limit. The program saves beneficiaries nearly $5,000 in Medicare Part D costs per year.

If you are eligible for Medicaid or any of the following Medicare Savings Programs, you automatically qualify.

• Specified Low-Income Medicare Beneficiary
• Qualifying Individual

With Extra Help, each generic prescription costs no more than $3.95, and each brand-name prescription does not cost more than $9.85.

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If you did not enroll in Medicare Part D when you first became eligible, you do not have to pay the late enrollment penalty if approved for the program. Approval waives this cost if you would otherwise owe the penalty.

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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Should I Sign Up For Medical Insurance

With our online application, you can sign up for Medicare Part A and Part B. Because you must pay a premium for Part B coverage, you can turn it down.

If youre eligible at age 65, your Initial Enrollment Period begins three months before your 65th birthday, includes the month you turn age 65, and ends three months after that birthday.

Note: Important Upcoming Change Rules for 2023 and later: If you accept the automatic enrollment in Medicare Part B or if you sign up during the first three months of your IEP, your coverage will start the month youre first eligible. Beginning January 1, 2023, if you sign up during the month you turn 65 or during the last three months of your IEP, your coverage starts the first day of the month after you sign up.

The following chart shows when your Medicare Part B becomes effective in 2022:

The following chart shows when your Medicare Part B becomes effective in 2023:

What Are The Medicare Extra Help Income And Resource Limits For 2022

You should apply if you think you qualify but your income exceeds the limits. You may still be eligible for Extra Help when your income is over the limit in some scenarios. These cases include when you or your spouse:

• Provide financial support for other family members currently living with you
• Earn money by working
• Reside in Alaska or Hawaii

Resource limits also apply when determining your eligibility. To be eligible for partial Extra Help, your resources must be equal to or below $15,510 as an individual or $30,950 with burial expenses as a married couple living together. Without burial expenses, the resource limit for an individual is $14,010 and $27,950 for a married couple.

To receive full Extra Help benefits, the resource limit with burial expenses for an individual is $9,900 and $15,600 for a married couple. Without burial expenses, the resource limit for an individual to receive full Extra Help benefits is $8,400 and $12,600 for a couple.

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The following examples count as resources:

• Money in bank accounts

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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

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How Social Security Determines You Have A Higher Premium

We use the most recent federal tax return the IRS provides to us. If you must pay higher premiums, we use a sliding scale to calculate the adjustments, based on your modified adjusted gross income . Your MAGI is your total adjusted gross income and tax-exempt interest income.

If you file your taxes as married, filing jointly and your MAGI is greater than $182,000, youll pay higher premiums for your Part B and Medicare prescription drug coverage. If you file your taxes using a different status, and your MAGI is greater than $91,000, youll pay higher premiums. See the chart below, Modified Adjusted Gross Income , for an idea of what you can expect to pay.

If you must pay higher premiums, well send you a letter with your premium amount and the reason for our determination. If you have both Medicare Part B and Medicare prescription drug coverage, youll pay higher premiums for each. If you have only one Medicare Part B or Medicare prescription drug coverage youll pay an income-related monthly adjustment amount only on the benefit you have. If you decide to enroll in the other program later in the same year, well apply an adjustment automatically to the other program when you enroll. You must already be paying an income-related monthly adjustment amount. In this case, we wont send you another letter explaining how we made this determination.

Remember, if your income isnt greater than the limits described above, this law does not apply to you.

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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

Ways To Get Help With Prescription Costs

You may find it necessary to get help paying for prescriptions even after enrolling in

. For example, you may reach the annual spending limit and enter what is called the coverage gap. Here are 5 tips to consider if you think you might need to get help with the costs of prescription drug coverage.

1. Consider switching to generics or other lower-cost drugs.

There may be generic or less-expensive brand-name drugs that would work just as well as the ones you’re taking now. Talk to your doctor to find out if these are an option for you. You might also be able to lower prescription costs by using mail-order pharmacies.

2. Choose a Medicare drug plan that offers additional coverage during the gap.

There are plans that offer additional coverage during the Medicare drug coverage gap, like for generic drugs. However, plans with additional gap coverage to help pay for prescriptions may charge a higher monthly

Check with the drug plan first to see if your drugs would be covered during the gap. Find health & drug plans.

3. Pharmaceutical Assistance Programs.

Some pharmaceutical companies offer programs to help pay for medications for people enrolled in Medicare drug coverage . Find out whether theres a Pharmaceutical Assistance Program that can lower prescription costs for the drugs you take.

4. State Pharmaceutical Assistance Programs.

• $3.95 for each generic covered drug
• $9.85 for each brand-name covered drug

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How Can You Get The Extra Help

To get Extra Help with Medicare prescription drug costs, you must complete and submit this application. The Social Security Administration will review your application and send you a letter to let you know if you qualify for Extra Help. SSA will also send you information about the Medicare Prescription Drug Coverage and tell you what you should do next.

NOTE: To apply, you must live in one of the 50 States or the District of Columbia.

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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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 arent 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.

Do You Think Youre 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 Medicares Limited Income Newly Eligible Transition Program at1-800-783-1307. TTY users can call 711.

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What Are The New Provisions Of Medicare

Part C: You can enroll in a Medicare Advantage plan to get your Medicare benefits. Medicare Advantage is the term used to describe the various private health plan choices available to Medicare beneficiaries.

Part D: There is a monthly premium for Part D coverage. Most Federal employees do not need to enroll in the Medicare drug program, since all Federal Employees Health Benefits Program plans will have prescription drug benefits that are at least equal to the standard Medicare prescription drug coverage. Still, you may want to be aware of the benefits Medicare is offering, so you can help others make informed decisions. If you have limited savings and a low income, you may be eligible for Medicare’s Low-Income Benefits. For people with limited income and resources, extra help in paying for a Medicare prescription drug plan is available. Information regarding this program is available through the Social Security Administration . For more information about this extra help, visit SSA online at www.ssa.gov, or call them at 1-800-772-1213 .

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, youll:

• Get help paying your Medicare drug plans 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.

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Applying 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 whether you qualify. You can choose a Medicare Part D prescription drug plan after becoming eligible for Extra Help. If you do not yet qualify, you can still look for a Medicare Part D plan that fits your budget and includes your prescriptions on the formulary.

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What Is This Application

This is an application for Extra Help with Medicare prescription drug costs. It does not enroll you in a Medicare prescription drug plan. To get that coverage, you will have to enroll directly with an approved Medicare prescription drug plan. If you need information about Medicare Prescription Drug plans or how to enroll in a plan, call Medicares toll-free number 1-800-MEDICARE or visit www.medicare.gov.

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Who Should Not Complete This Application For Extra Help With The Medicare Prescription Drug Plan Costs

You should not complete this online application if:

• You receive Medicaid and have Medicare, or
• Your State pays for your Medicare premiums , or
• You receive Supplemental Security Income payments and have Medicare.

If you are in one of the 3 groups above, you will automatically get the Extra Help and do not need to apply.

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.

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