What is Extra Help?
Extra Help is a federal program run by Social Security that lowers out-of-pocket prescription drug costs for Medicare beneficiaries with limited income and resources. Depending on your situation, it can:
- Lower or eliminate your Part D monthly premium
- Lower your Part D deductible
- Reduce what you pay at the pharmacy to small flat co-pays
- Eliminate the Part D late-enrollment penalty
- Give you a Special Enrollment Period to change plans
Who qualifies?
You may qualify for Extra Help if your income and resources are below federally set limits. These limits change each year, so always check the current thresholds at ssa.gov/medicare/part-d-extra-help.
You automatically qualify if you have any of the following:
- Medicaid (full dual-eligible or partial)
- Supplemental Security Income (SSI)
- A Medicare Savings Program (QMB, SLMB, or QI)
If you have any of these, Medicare and Social Security send you a notice and enroll you in Extra Help automatically.
Many people who don'thave these programs also qualify based on the income and resource limits, but they have to apply. If your situation is borderline, it's almost always worth applying because:
- The application is free
- It doesn't affect your other benefits
- Many people who qualify don't realize it
How much does Extra Help save?
There are different levels of Extra Help. The full benefit can mean:
- $0 Part D monthly premium (for benchmark plans)
- $0 Part D deductible
- Small flat co-pays per prescription (a few dollars) instead of regular cost-sharing
For someone with high prescription drug costs, the annual savings can run into the thousands of dollars.
How to apply
Three ways to apply:
- Online at ssa.gov/medicare/part-d-extra-help, takes about 15 minutes
- By phone at 1-800-772-1213 (TTY 1-800-325-0778)
- In person at your local Social Security office
You'll need to provide information about your income, resources, and household. Social Security will send you a determination notice, and if approved, you'll start saving on your next prescription fill.
Medicare Savings Programs (separate but related)
Beyond Extra Help, your state may run a Medicare Savings Program that helps pay your Part B premium and sometimes other Medicare costs. The main programs are:
- QMB (Qualified Medicare Beneficiary): pays Part A and Part B premiums, deductibles, and coinsurance
- SLMB (Specified Low-Income Medicare Beneficiary): pays the Part B premium
- QI (Qualifying Individual): pays the Part B premium (funding is limited)
- QDWI (Qualified Disabled and Working Individual): pays Part A premiums for certain working disabled people
Eligibility, income limits, and resource limits vary by state. Apply through your state Medicaid office.