With Medicare Annual Enrollment round the corner (starts on Oct 15th and ends on Dec 7th), ensure you maximize Medicare benefits available to you. One such benefit is Extra Help (also called Low Income Subsidy).
This article is part of the “Maximize your Benefits” series put out by The Seniors Club to help seniors maximize their benefits.
What is Extra Help?
Extra Help is a Medicare program administered by the Social Security Administration (SSA). This program helps Medicare beneficiaries with limited income and resources pay for their prescription drugs.
Social Security currently estimates the value of this benefit to be about $5,100 per year.
How to get Extra Help from Medicare?
You automatically qualify and are enrolled in Extra Help if:
- You have full Medicaid coverage
- Get help from the state to pay Medicare Part B premiums
- Get Supplemental Security Income (SSI) from Social Security
If you think you automatically qualify but aren’t receiving the benefit currently, please contact the Social Security Administration (SSA).
|
If you DO NOT automatically qualify to enroll in Extra Help, here are the requirements.
2023 Eligibility Requirements for Extra Help
Enrollment in Medicare
Income Limit: Your previous year income should be below $20,385 (individual) or $27,465 (married couple)
Resource (Assets) Limit*: The total value should be below $15,510 (individual) or $30,950 (married couple)
* According to Medicare, the following account towards your resource limit: Money in a checking or savings account, Stocks & Bonds; Not included: Your home, One car, Burial plot, Up to $1,500 for burial expenses if you have put that money aside, Furniture, Other household and personal items.
You can check to see if you qualify at this Social Security Administration (SSA) Webpage
2023 Extra Help Benefits
- Use of Prescription Drug Coverage (Medicare Part D)
- Qualify to make changes to your Medicare plans outside of Annual Enrollment Period (AEP runs between Oct 15 and Dec 7)
How much help you get depends on your income and asset value. The two categories are:
- Full Help
- Partial Help
Full Help
- Plan Premiums: Waived in full
- Plan Deductibles: Waived in full
- Copays: Up to $3.95 for generic drugs; up to $9.85 for brand-name drugs
When the total cost (what you and the plan pay) reaches the threshold amount of $7,050 for the year, you have no copays.
Partial Help
- Plan Premiums: Vary on a sliding scale based on your income
- Plan Deductibles: Total annual amount not to exceed $99
- Copays: 15% of drug cost
When the total cost (what you and the plan pay) reaches the threshold amount of $7,050 for the year, you pay up to $3.95 for generic drugs and up to $9.85 for brand-name drugs
Other options if you don’t qualify for Extra Help
Check to see if your state has a pharmaceutical assistance program at this Medicare.gov webpage.
If you are looking for assistance paying for a specific drug, click on this Medicare.gov link to search by drug name.
Additional Resources
Checkout the National Council on Aging’s (NCOA) website BenefitsCheckup.Org. Enter your zip code to checkout benefit programs available in your area.
About The Seniors Club
The Seniors Club is a National Association for Seniors & Baby Boomers, providing its members a wide range of benefits and discounts. The membership is free and you can cancel anytime with no obligation. Check us out and/or join the Club.
Disclaimer: This website and its contents are for informational purposes only. Medicare has neither reviewed nor endorsed the information on our site. The Seniors Club is neither endorsed by nor contracted with the US Government, or any federal/ state programs. The Seniors Club does not recommend health related products, services, or insurance plans. You are strongly encouraged to evaluate your needs. The Seniors Club is a privately-owned non-government website.
