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How does Medicare Extra Help work?
The purpose of the Medicare Low Income Subsidy, also known as the Medicare Extra Help Program, is to assist people with fixed incomes in covering some or even all of the out-of-pocket expenses for Medicare Part D. The Part D Low-Income Subsidy is another name for it.
It’s crucial to keep in mind that Extra Help is neither a substitute for Part D or a plan on its own. To obtain Extra Help with Medicare prescription medication coverage, you must still have a Part D plan. However, Medicare Part C, sometimes referred to as Medicare Advantage, frequently offers medication coverage in place of a separate Part D plan.
Medicare Extra Help Eligibility Requirements and Income Caps
Your eligibility for full or partial Extra Help will depend on your income and assets. The costs of prescription medications are reduced by both.
You might automatically qualify for Extra Help if any of the following apply, in which case you won’t need to submit an application:
- You receive Supplemental Security Income (SSI),
- Are dual eligible (i.e., enrolled in both Medicaid and Medicare), and/or
- Meet the requirements for a Medicare Savings Plan.
For more information, please visit https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d
Benefits under Medicare Extra Help
Your income and available resources will determine how much financial assistance you can receive from Extra Help, although most Extra Help recipients will pay:
- No premiums (up to the state standard; state-specific)
- No medicine copayments
- Each drug covered by the plan must cost no more than $4.15 for generic and $10.35 for brand-name drugs.
Beneficiaries of Extra Help also receive the following advantages:
- Once every three months, from January through September, you can enroll in or change your Medicare Part D drug plan. You can switch plans without having to wait until the Medicare Advantage & Prescription Drug Plan Annual Enrollment Period (October 15 – December7). The following month becomes the effective date for any plans created outside of the Medicare Annual Enrollment Period. Those who might need to start taking medications that are not on the approved drug list of the current plan may find this benefit to be of particular use.
- There is no Part D late enrollment penalty. This is true even if you enroll after becoming qualified for a Part D plan for the first time and have no other drug coverage.
For more information, please visit https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d
How to Submit a Low Income Subsidy Application
Application for ‘Extra Help with Medicare Prescription Drug Plan Costs along with your Social Security is all that is necessary to submit an application for Medicare Low Income Subsidy. Steps are as under:
- Submitting an online application at www.ssa.gov/benefits/medicare/prescriptionhelp
- Dialing 888-977-1399 to reach Social Security
- Filling out an application in person at a nearby Social Security office.
For more information, please visit https://www.medicare.gov/your-medicare-costs/get-help-paying-costs/find-your-level-of-extra-help-part-d
How to Request Low Income Assistance
Simply submit a form titled ‘Application for Extra Help with Medicare Prescription Drug Plan Costs’ with your Social Security to request Medicare Low Income Subsidy.
- Applying online at www.ssa.gov/benefits/medicare/prescriptionhelp is one way to do this.
- Making a call to 888-977-1399 for Social Security
- Submitting a personal application at a nearby Social Security office.
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