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Medicare Extra Help Programs: Income Limits and Benefits

Medicare Extra Help Programs: Income Limits and Benefits

If you have a lower income, you might wonder how you can afford your Medicare costs. For example, your Medicare Part D prescription drug coverage has a monthly premium, deductible, and copayment for prescriptions.

If you need help paying for those costs, you should consider the Medicare Extra Help program. This guide will help you understand how to use this program and answer common questions that many Medicare beneficiaries have.

What is Medicare Extra Help?

The Extra Help program helps those who struggle to afford their Medicare Part D prescription drug plan. In order to apply, you have to be enrolled in Medicare Part D. You might qualify for either full extra help or partial assistance.

The enrollment you qualify for depends on your monthly income, assets, and other programs you qualify for.

If you qualify for Medicaid, SSI, or a Medicare Savings Program, you automatically receive Extra Help on your Medicare Part D plan. You don’t need to enroll, you simply need to send a copy of the qualifying notice to your drug plan.

Qualifying for Extra Help provides you with a special enrollment opportunity each quarter (except 4th quarter) to change Part D plans to make sure the plan you are in fits your needs.

What Does Medicare Extra Help Pay For?

Medicare Extra Help allows you to get assistance paying for your monthly premium, and deductibles. ,

The extra help you receive includes:

  • Paying your Part D monthly premium and deductible
  • Pay a lower copayment for prescription drugs
  • Removes any Part D late enrollment penalty you might have

The specifics of how much you pay will depend on the level of Extra Help you qualify for.

For example, partial Extra Help allows you to pay no more than 15% of the cost of the drug, and full Extra Help gives you a copayment of $9.20 in 2021 for name-brand drugs, ($9.85 in 2022) and $3.70 in 2021 for generics ($3.95 in 2022).

Of course, if your normal Part D copayment is lower than that, you pay the lower amount.

Medicare Extra Help Income Limits

Many people ask, “What are the income limits with Extra Help with Medicare?” These income limits change from year to year and are based on whether you live alone or as a couple. You also must live in one of the 50 states or the District of Columbia.

What are the income limits for Extra Help with Medicare in 2021?

For 2022, our resource limits must be below $27,950 for a couple, and $14,010 if you are not married or living alone. Your primary residence, vehicles, personal property, life insurance, and burial plots are not included in this total.

Government assistance such as food stamps, housing assistance, and utility help is not counted in the income.

Medicare Extra Help Benefits

The primary benefit of Medicare Extra Help is to make your Medicare Part D plan more affordable. There are a lot of Medicare beneficiaries who struggle to make ends meet due to being on a fixed income or losing a spouse who was a source of income.

With Medicare Extra Help, you can receive partial or full assistance paying for your Medicare Part D monthly premium and deductible, along with adjustments to your copayment for specific drugs. It’s a major benefit, especially for those who need a lot of prescription medication.

Medicare Savings Programs (MSP)

In addition to Extra Help with Medicare Part D, you may qualify for Medicare Savings Programs (MSP) that help you with costs you may have for Medicare Parts A and B. There are four programs, each one with different qualifying criteria when it comes to income and assets.

  1. The Qualified Medicare Beneficiary program provides the most assistance, paying for Part A and B premiums, deductibles, and coinsurance or copayments.
  2. The Specified Low-Income Medicare Beneficiary Program pays for Part B premiums only.
  3. The Qualifying Individual program helps pay for Part B premiums.
  4. The Qualified Disabled and Working Individuals Program helps pay the Part A premium if you lose premium-free Part A because you went back to work and you have a qualifying disability.

You can learn more about these programs in our Medicare Savings Programs guide.

Learn More About Medicare Extra Help Programs

Medicare Extra Help can allow you to save thousands of dollars for costs related to your Medicare Part D plan. This guide addressed many common questions, but you might still need more information. Talking to a licensed insurance agent can help. Contact us today to discuss your Medicare options with a licensed professional.

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