Medicare 101

Extra Help From Medicare for Prescription Drug Costs

Christian Worstell

by Christian Worstell | Published October 08, 2020 | Reviewed by John Krahnert

If you have Medicare Part D prescription drug coverage, you will likely have to pay a monthly premium as well as annual deductibles and copayments. The Extra Help program can help cover some of these costs.

Depending on the level of Extra Help that you qualify for, you may only pay a portion of the Medicare Part D drug plan premiums and deductibles.

Your level of qualification depends on your reported financial resources.

Stethoscope and prescriptioin

How Do I Qualify for Extra Help?

You may automatically qualify for Extra Help if you have Original Medicare (Part A and Part B) and meet any of the following conditions:

  • You have full Medicaid benefits coverage

  • Your state Medicaid program helps pay for your Part B premiums

  • You receive Supplemental Security Income (SSI)

The federal government will send you notices regarding your Extra Help coverage qualification, which may change from year to year depending on your income and resources.

If you do not automatically qualify, you can complete an online Extra Help program application through the Social Security Administration.

It is important to note that you cannot apply for Extra Help until you are enrolled in Medicare Part A, Part B and a Part D prescription drug plan.

You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

Only complete the application if you meet the following financial circumstances in 2019:

  • Your combined savings, investments and real estate do not equal more than $14,390, and you aren't married or living with a spouse

  • Your combined savings, investments and real estate do not equal more than $28,720, and you are married and live with your spouse

Do not count your vehicles, life insurance plans, burial plots, back payments from Social Security or SSI, irrevocable burial contracts or your home in the above financial totals.

If you have questions or are unsure if you qualify for Extra Help, you may be able to find help from your state Medicaid office or your State Health insurance Assistance Program.

Medicare Supplement Insurance Plans Can Help Cover Other Costs 

In most states, there are 10 standardized Medicare Supplement Insurance (Medigap) plans, labeled A, B, C, D, F, G, K, L, M and N. These plans are sold by private insurance companies to help cover some of Original Medicare’s out-of-pocket costs.

Plan availability varies by location, so speak with a licensed insurance agent to find out which options are available in your area.

All 10 Medigap plans must provide coverage for:

  • Medicare Part A coinsurance for hospital care

  • Medicare Part A coinsurance/copayment for hospice care

  • Medicare Part B coinsurance or copayment

  • Your first three pints of blood

While Medigap plans do not help cover prescription drug costs like the Extra Help program, they can help cover some of your other Medicare out-of-pocket costs.

For help finding a Medigap plan, or help choosing which plan option is right for you, call today to speak with a licensed insurance agent.

 

Find Medigap plans in your area.

Compare Plans
Or call 1-800-995-4219 to speak with a licensed insurance agent.

 

Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

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