Medicare Offers Help with Prescription Drug CostsPosted by Medicare Made Clear
Extra Help is a Medicare program that assists qualified beneficiaries with paying for their prescription drugs. You could get help paying your Part D premiums, deductibles and copays.
For most people who qualify, 2013 copays will be no more than:
- $2.65 for each covered generic drug
- $6.60 for each covered brand name drug
Other qualified individuals may pay only a portion of their 2013 Part D premiums and deductibles based on their income level.
Do You Qualify?
You need to meet certain income and resource limits to qualify for the Extra Help program. In 2013, you may qualify if you have up to $17,235 in yearly income ($23,265 for a married couple) and up to $13,300 in resources ($26,580 for a married couple).
Resources that count toward your total include:
- Money in checking, savings, IRA and investment accounts
Your primary residence, car, burial plot and up to $1,500 (per person) for burial expenses, life insurance policies, furniture and other household and personal items do not count.
You may automatically qualify for Extra Help if you have Medicare and meet any of these conditions:
- You have full Medicaid coverage.
- You get help from your state Medicaid program paying your Part B premiums (in a Medicare Savings Program).
- You get Supplemental Security Income (SSI) benefits.
Contact your Part D plan sponsor if you think you may qualify automatically. They can help you understand what information you need to provide in order to get started.
Even if you automatically qualify for Extra Help one year, you may not another year if your income or resources change. If you no longer automatically qualify in a given year, you’ll get a notification (on grey paper) by the end of September. You may still qualify for the program, but you’ll need to apply to find out.
How to Apply
You can apply for Extra Help online at Social Security.gov. You may also visit a Social Security office in your community or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) 7 a.m. – 7 p.m. local time Monday through Friday. Social Security will send a written notice telling you whether or not you qualify for the program.
The Extra Help application process does not enroll you in a prescription drug plan. You need to find a plan in your area and enroll. The sooner you join a plan the sooner you can begin receiving benefits. If you already have a Part D prescription drug plan, then you need to let the plan know if you have qualified for Extra Help.
Other Ways to Lower Drug Costs
If you don’t qualify for Extra Help, your state may have programs that can help pay your prescription drug costs. Contact your State Medical Assistance (Medicaid) office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.
In addition, you can:
- Ask your doctor if there are generic drugs that will work as well as your current brand-name drugs. Generic drugs are generally cheaper than their brand name equivalents.
- Ask your doctor about less expensive brand name drugs.
- Consider using mail order pharmacies. Many prescription drug plans offer a mail order benefit.
- Use the Medicare Plan Finder to compare Medicare drug plans. Costs vary from plan to plan. You may find one with lower costs.
- Find out if your state offers help paying for drug costs.
- Find out if the company that makes your drug offers help paying for it.
For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.
SocialSecurity.com: Learn more about the Extra Help program and apply online.
Medicare Prescription Drug Coverage: Get information about Medicare Part D.
Medicare.gov: Visit the official U.S. government site for Medicare.