| Thu, Oct 01, 2015 @ 09:00 AM

Medicare Part D Can Be Costly. Financial Assistance May Help.

Posted by Medicare Made Clear

medicare extra helpIf you have trouble paying for your Medicare Part D plan, you may qualify for a type of financial assistance called Extra Help.

Extra Help is a Medicare program designed to help people with limited income and resources pay Medicare prescription drug program costs like premiums, deductibles and coinsurance. Extra Help is estimated to be worth about $4,000 per year per beneficiary.1

Who Qualifies for Extra Help and What Kind of Documentation do You Need?

You need to provide proof to the Part D plan that you want to enroll in that you qualify for Extra Help. The plan will inform you as to how much Extra Help you are eligible for once they receive the proper documentation from you.

There are certain types of documentation you can use to show you qualify for Extra Help.

If you receive a Purple notice from Medicare, this means you are automatically qualified and enrolled in Extra Help because you’ve met one or more of the following requirements.

  • You have both Medicare and Medicaid.
  • You’re in a Medicare Savings Program.
  • You get Supplemental Security Income (SSI)

If you receive a Yellow notice from Medicare, this means you automatically qualify for Extra Help because you’ve met all of the following requirements. Medicare will automatically enroll you in a Medicare Part D plan unless you decline coverage or join a plan yourself.

  • You qualify for both Medicare and Medicaid.
  • You currently get benefits through Original Medicare.

If you receive an Orange notice from Medicare, this means the Social Security Administration is informing you that you still qualify for Extra Help, but your copayment will be different next year.

If you receive a Social Security LIS & MSP Outreach Notice from the Social Security Administration, this means you might be eligible for Extra Help and/or a Medicare Savings Program (MSP). You can apply for Extra Help at Social Security or a Medicaid office.

Other Types of Documentation

If you don’t have any of the documents above, you can use what is called “Best Available Evidence.” According to Medicare.gov, this includes2:

  • Documentation showing you have Medicaid and live in an institution or get home- and community-based services. For example:
    • A bill from the institution (like a nursing home) or a copy of a state document showing Medicaid paid for your stay for at least a month.
    • A print-out from your state’s Medicaid system showing that you lived in an institution for at least a month and that Medicaid paid for your stay.
    • A document from your state that shows you have Medicaid and are getting home- and community-based services.
  • Other proof you have Medicaid, such as:
    • A copy of your Medicaid card
    • A copy of a state document that shows you have Medicaid
    • A print-out from a state electronic enrollment file or from your state’s Medicaid systems that shows you have Medicaid
    • Any other document from your state that shows you have Medicaid
  • Documents showing you have Medicare
    • Contact Medicare so they can send you proof that you qualify. You can expect your request to take anywhere from several days to up to 2 weeks to process, depending on the circumstances. Call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day/7 days a week.
  • Other proof you have Medicare
  • Request a Benefit Verification Letter from the Social Security Administration. A Benefits Verification Letter is used to show that you are (or are not) receiving Medicare or Social Security benefits. Request your benefits verification letter online by signing in at my Social Security. If you prefer to request your letter by phone, you can call the Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778), Monday through Friday from 7 a.m. to 7 p.m. Read more about it here.

Once you have turned in the necessary information to your plan and the paperwork is complete, your plan must make sure you pay no more than the LIS drug coverage cost limit.

  • In 2015, drug costs for most people who qualify are no more than $2.65 for each generic drug and no more than $6.60 for each brand-name covered drug.
  • In 2016, drug costs will be no more than $2.95 for each generic drug and no more than $7.40 for each brand-name covered drug.2

Read more about Extra Help, its eligibility requirements, caregiver resources, information, forms and more at the Security Social Administration.

For more information, explore MedicareMadeClear.com or 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.


Apply for Extra Help with Medicare Prescription Drug Plan Costs: SocialSecurity.gov

Find Your Level of Extra Help (Part D): Medicare.gov

Medicare Offers Help with Prescription Drug Costs: Medicare Made Clear


1 Extra Help with Medicare Prescription Drug Plan Costs, Social Security Administration, August 22, 2015

2 Find Your Level of Extra Help (Part D), Medicare.gov, August 24, 2015

3 Auto-Enrollment Notice, Medicare.gov, August 28, 2015


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