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
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
When Can You Submit Your Application
This service is available during the following hours :
Monday through Friday: 5:00 AM 11:00 PMSaturday: 5:00 AM 9:00 PMSunday: 8:00 AM 8:00 PMHolidays: 5:00 AM 9:00 PM
* Social Security accepts applications during certain hours. We recommend that you begin at least one hour before the latest time listed above to ensure your application will be processed.
If you need help completing this application, to find a local agency in your community, or call Social Security toll-free at 1-800-772-1213.
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Having Trouble Paying Your Prescription Drugs
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 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.
Drug costs in 2019 for people who qualify for Extra Help will be no more than $3.40 for each generic drug and $8.50 for each brand-name drug.
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.
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Already Enrolled In Medicare
If you have Medicare, you can get information and services online. Find out how to .
If you are enrolled in Medicare Part A and you want to sign up for Part B, please complete form CMS-40B, Application for Enrollment in Medicare Part B . If you are applying for Medicare Part B due to a loss of employment or group health coverage, you will also need to complete form CMS-L564, Request for Employment Information.
You can use one of the following options to submit your enrollment request under the Special Enrollment Period:
- State I want Part B coverage to begin in the remarks section of the CMS-40B form or online application.
- If possible, your employer should complete Section B.
- If your employer is unable to complete Section B, please complete that portion as best as you can on their behalf and submit one of the following forms of secondary evidence:
- Income tax form that shows health insurance premiums paid.
- W-2s reflecting pre-tax medical contributions.
- Pay stubs that reflect health insurance premium deductions.
- Health insurance cards with a policy effective date.
- Explanations of benefits paid by the GHP or LGHP.
- Statements or receipts that reflect payment of health insurance premiums.
Some people with limited resources and income may also be able to get .
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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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.
|Extra Help Level:
you can reapply for Extra Help any time
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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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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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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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.
Medicare Part D Prescription Drug Coverage
The University of Michigan strongly urges Medicare-eligible prescription drug plan members and their enrolled dependents not to enroll in Medicare Part D except under certain circumstances:
- Active employees and dependents do not enroll in Medicare Part D
- U-M retirees or employees on long-term disability only enroll in Medicare Part D if you apply for and are approved for Medicare low-income prescription drug assistance. The university advises you to continue your U-M health plan in this case.
The U-M prescription drug plan offers more comprehensive coverage and lower out-of-pocket costs for most members than Medicare Part D. If you do not enroll in Medicare Part D and continue your enrollment in the universitys health insurance plan , you will be able to enroll in Medicare Part D in later years without any financial penalty.
If you enroll in a Medicare Part D plan, your Medicare Part D plan will be your primary prescription drug coverage and must be billed first. You must follow all Medicare Part D rules and policies when filling prescriptions. Your U-M drug plan administered by Magellan Rx will provide secondary coverage and should be billed after Medicare Part D.
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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.
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 .
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Who Should Complete This Application For Extra Help With Costs Under The Medicare Prescription Drug Coverage
You should complete this online application for Extra Help if:
- You have Medicare Part A and/or Medicare Part B and
- You live in one of the 50 states or the District of Columbia and
- Your income is below $20,625 if you are not currently married or not living with your spouse, or $27,705 if you are currently married and living with your spouse and
- Your combined savings, investments, and real estate are not worth more than $15,510 if you are not currently married or not living with your spouse, or $30,950 if you are currently married and living with your spouse.
If you have more than those amounts, you may not qualify for the Extra Help. However, you can still enroll in an approved Medicare prescription drug plan for 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 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.
If Your Income Has Gone Down
If your income has gone down and the change makes a difference in the income level we consider, contact us to explain that you have new information. We may make a new decision about your income-related monthly adjustment amount for the following reasons:
- You married, divorced, or became widowed.
- You or your spouse stopped working or reduced your work hours.
- You or your spouse lost income-producing property because of a disaster or other event beyond your control.
- You or your spouse experienced a scheduled cessation, termination, or reorganization of an employers pension plan.
- You or your spouse received a settlement from an employer or former employer because of the employers closure, bankruptcy, or reorganization.
If any of the above applies to you, we need to see documentation verifying the event and the reduction in your income. The documentation you provide should relate to the event and may include a death certificate, a letter from your employer about your retirement, or something similar. If you filed a federal income tax return for the year in question, you need to show us your signed copy of the return. Use Form Medicare Income-Related Monthly Adjustment Amount Life-Changing Event to report a major life-changing event. If your income has gone down, you may also use Form SSA-44 to request a reduction in your income-related monthly adjustment amount.
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