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Finding Medicare Extra Help

Medicare Extra Help Made Easy

Extra Help benefits

The Extra Help program offers the following benefits:

  • Pays for your Part D premium up to a state-specific benchmark amount
  • Lowers the cost of your prescription drugs
  • Gives you a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans (You cannot use the Extra Help SEP during the fourth calendar quarter of the year (October through December). You should use Fall Open Enrollment during this time to make prescription drug coverage changes.)
  • Eliminates any Part D late enrollment penalty you may have incurred if you delayed Part D enrollment

Depending on your income and assets, you may qualify for either full or partial Extra Help. Both programs aid with the cost of your drugs. To receive such assistance, your prescriptions should be on your plan’s formulary, and you should use pharmacies in your plan’s network.

Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive Medicare prescription drug coverage and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.

Basic Medicare does not cover acupuncture, dental services, help with dressing and other custodial care, certain eye care, hearing aids, and some other goods and services. It pays for only a limited number of visits to speech and occupational therapists and covers only about half of the outpatient mental health services.

Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs).

Medicaid also covers additional services beyond those provided under Medicare, including nursing facility care beyond the 100-day limit or skilled nursing facility care that Medicare covers, prescription drugs, eyeglasses, and hearing aids. Services covered by both programs are first paid for by Medicare with Medicaid filling in the difference up to the state’s payment limit.

There are special Medicare Advantage Plans called Dual Eligible Plans for individuals who qualify for both Medicare and Extra Help (Medicaid).


Medicaid is a joint federal/state program that helps with medical costs for some people with limited income and resources.

Medicare Savings Programs

State Medicare Savings Programs (MSP) programs help pay premiums, deductibles, coinsurance, copayments, and prescription drug coverage costs.


PACE (Program of All-inclusive Care for the Elderly) is a Medicare/Medicaid program that helps people meet health care needs in the community.

Save on drug costs

If you meet certain income and resource limits, qualify for extra help from Medicare to pay the costs of Medicare prescription drug coverage.

Programs for people in U.S. territories

Programs in Puerto Rico, U.S. Virgin Islands, Guam, Northern Mariana Islands, and American Samoa, for people with limited income and resources.

Find your level of Extra Help (Part D)

Your level of extra help with Medicare prescription drug costs is described on a purple, yellow, green, or orange-colored notice from Medicare.

Insure Kids Now

The Children’s Health Insurance Program (CHIP) provides free or low-cost health coverage for more than 7 million children up to age 19. CHIP covers U.S. citizens and eligible immigrants.

Supplemental Security Income (SSI)

The Supplemental Security Income (SSI) program pays benefits to disabled adults and children who have limited income and resources. SSI benefits also are payable to people 65 and older without disabilities who meet the financial limits.

Where to apply for Medicaid:


If you have any questions about Original Medicare (Medicare Part A and Part B), Extra Help, Medicare Supplement Plans (Medigap), Medicare Advantage (Part C), or Prescription Drug Plans (Part D), RightFitPlans.com is at your service. For the best health care coverage at the absolute best price, why not give Sonia a call today?

You can also visit Texas Health & Human Services.

Next, learn: Cost of Medicare

Source: medicare.gov