Need Medicare Help?

Medicare Extra Help

Are you a Medicare beneficiary struggling with the cost of prescription drugs? A program called Extra Help offsets the cost of prescriptions for Medicare beneficiaries with Part D. If you have limited resources, you might qualify. We’re here to help you understand how Extra Help works with Part D, who’s eligible, how to apply, and more.

Extra Help with Your Medicare Prescription Drug Plan Costs

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

Getting Extra Help with your Part D can:

• Reduce your out-of-pocket costs for prescription drugs
• Eliminate your monthly Part D premiums
• Reduce or eliminate your annual Part D deductibles
• Eliminate the coverage gap, also known as the donut hole. This means your prescriptions won’t cost more just because you went over a spending limit in a particular year

On average, Extra Help is estimated to save beneficiaries $5,000 in these costs per year.

If you’re eligible for Medicaid or any of the following Medicare Savings Programs, you automatically qualify for Extra Help.

• Qualified Medicare Beneficiary (QMB)
• Specified Low-Income Medicare Beneficiary (SLMB)
• Qualifying Individual (QI)

For those enrolled in Extra Help, generic prescription costs are no more than $3.60 each, and brand-name prescription costs are no more than $8.95 each.

If you didn’t enroll in Part D when you first became eligible, you won’t have to pay the late enrollment penalty if you have Extra Help.

What Are the Income and Resource Limits for Extra Help in 2022?

The Centers for Medicare & Medicaid Services (CMS) is releasing guidance on the updated resource limits for individuals who apply and qualify for the low-income subsidy (LIS). As described at 42 CFR 423.772, resources include bank accounts, stocks, bonds, and other liquid resources that can be readily converted to cash within 20 days, as well as real estate that is not the beneficiary’s primary residence.

CMS is also providing the maximum copayments that LIS-eligible beneficiaries, including full benefit dual eligible and partial dual eligible individuals, will pay as enrollees of Medicare prescription drug plans in 2022. Please note that the LIS copayment figures were announced in the January 15, 2021, guidance entitled, “Announcement of Calendar Year (CY) 2022 Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies.”

The 2022 resource limits are $8,400 ($12,600 if married) for the full low-income subsidy and $14,010 ($27,950 if married) for the partial low-income subsidies. If beneficiaries notified the Social Security Administration (SSA) that they expect to use some of their resources for burial expenses, pursuant to 20 CFR § 416.1231, the 2022 resource limits are $9,900 ($15,600 if married) for the full low-income subsidy and $15,510 ($30,950 if married) for the partial low-income subsidies. Please see the attached notice for more information regarding the methodology that CMS used to update the low-income subsidy resource limits and cost-sharing amounts for 2022.

CMS is also required to update income standards for the low-income subsidies each year and
will release the 2022 income standards for the low-income subsidies in early 2022, after the 2022
Federal poverty levels (FPL) are released.

Levels of Extra Help

If your income and resources are greater than the limits listed above, you can still qualify for partial Extra Help. There are levels of Extra Help that depend on your income and resources.

You can mail your color-coded document to your Part D plan to help verify the level of Extra Help for which you qualify. Those who are dual-eligible to receive Medicare and Medicaid qualify for full Extra Help.

How to Apply 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 of whether you qualify for Extra Help. You can choose a Part D prescription drug plan after you qualify for Extra Help. If you haven’t qualified, you can still look for a Part D plan that fits your budget and includes your prescriptions in the formulary.

If you need assistance applying for extra help call Ashford Insurance at 817-952-3153.