Extra Help is a federal program that helps low-income Medicare beneficiaries with limited resources pay for prescription drugs using Medicare Part D.
«These programs are really important and can save people thousands of dollars a year,» said Erin Guay, paralegal and compliance officer with the Pennsylvania Health Law Project. If you qualify, the government estimates Extra Help is worth about $5,100 a year.
If you’re struggling to afford your prescription drugs, the Medicare Extra Help program — also known as Part D Low-Income Subsidy — may be able to help. Here’s what you need to know about Extra Help benefits, requirements, and the application process.
What are the benefits of Extra Help?
Part D Premium Grants up to 100% of the cost of Benchmark Part D awards in your region. (You’ll have to pay the difference if you opt for a more expensive Part D plan.)
Reduced or eliminated Part D deductibles.
Co-payment caps for prescription drugs As low as $1.35 for generic and $4 for branded drugs.
If you are not entitled to full benefits, in some cases you can still receive partial benefits, which are graduated according to income and assets.
Who is entitled to extra assistance?
You may qualify for Extra Help if you are eligible for Medicare Part A or part B, live in any of the 50 states or in Washington, DC, are not incarcerated and have both limited resources and limited income.
Receiving assistance from the government programs listed below may also qualify you to automatically receive additional assistance.
Who automatically gets extra help?
You are automatically eligible for Extra Help if you have Medicare Part A or Part B and at least one of the following applies:
You are eligible for Supplemental Security Income or SSI.
You are fully eligible Medicaid Cover.
You are enrolled in a Medicare savings program as a Qualified Medicare Beneficiary, Designated Low-Income Medicare Beneficiary, or Qualified Person.
If you qualify automatically, you do not have to apply to receive the benefits.
If you don’t automatically qualify, you should still apply for Extra Assistance if you could meet the income and resource criteria.
What are the resource and income limits for Extra Help?
“Resources” include your bank accounts, investments such as stocks and bonds, and real estate other than your primary residence.
For 2022, the Extra Help resource limits are:
Limit for partial grants
Extra Help’s resource constraints aren’t as restrictive as other government programs, Guay says. For example, your home, personal belongings, vehicles, insurance policies, back payments from Social Security or SSI, and burial sites or contracts do not count toward resource limits.
Additionally, using some resources to pay for a funeral or burial increases the limits by $1,500 for a single person or $3,000 for a married couple.
Extra Help income limits are based on Federal Poverty Level or FPL. The income limits for people in the contiguous states and the District of Columbia (numbers are different for Alaska and Hawaii) are:
Limit for partial grants
$1,610 per month or $19,320 per year.
$1,449 per month or $17,388 per year.
$2,178 per month or $26,130 per year.
$1,960 per month or $23,517 per year.
The latest income thresholds for all states and household sizes can be found on the Department of Health and Human Services website. HHS Poverty Guidelines for 2021.
As with resources, there are many exceptions to what counts as income. For example, food, housing and household help from the government, scholarships, grants and even payments you receive from others to help with your household expenses do not count against the Extra Help income limits.
How do I request additional help?
You apply for Extra Help through the Social Security Administration:
You can usually apply in person at a social security office, but offices are closed to walk-in customers during the COVID-19 pandemic. You may be able to make a special appointment for personal assistance if you call first.
As part of the application, you must provide information about your household, work, resources, and monthly income.
«The application process is actually much simpler than other benefit programs because you have to fill out an application but typically don’t have to provide income and resource documentation like you often do with Medicaid or the Medicare savings programs.» Guay says, «Social Security can usually verify the information you submit.”
What if I don’t qualify?
Even if you think you might not qualify, Guay recommends applying just to be safe.
«Apply and get an actual official decision explaining how your income was counted,» says Guay. “Then if you are denied, you can look at the reason why you were denied the decision if you want to appeal that decision. Or you will receive a notification that you are eligible.”
There are other programs that could also help, particularly at the state level. «In Pennsylvania, we have a prescription program for seniors,» says Guay. «If people don’t qualify for Extra Help, they might be eligible for some of these other prescription programs that could limit their Medicare costs.»