If you are age 65 or older and on Medicare, it’s important you know about the Extra Help Program, Medicare Prescription Drug Coverage (Part D). This is a federal program that can help you pay for some of your out-of-pocket costs for prescription drugs. The plan is also commonly known as the Part D Low-Income Subsidy or LIS. This program can be a great benefit to anyone who is struggling to pay for their prescription costs that Medicare doesn’t cover.

Am I Eligible for Medicare’s Extra Help Program?

You may be eligible for the Extra Help Program (Medicare Prescription Drug Coverage) if any of the following factors apply to you.

The income limits can change each year as the cost of living changes. In 2020, if your monthly income is $1,615 or less (or up to $2,175 for couples), and your assets are also below the specified limits, you could be eligible for the Extra Help program. These limits do include the $20 income disregard that the Social Security Administration (SSA) automatically removes from your unearned income, or retirement income. However, even if your income and assets are above the limits, it’s possible to still qualify for the program. That’s because certain types of income and assets may not count against you when it comes to the Extra Help program. If you receive Supplemental Security Income (SSI), are enrolled in Medicaid, or the Medicare Savings Program, you’re automatically qualified for the Extra Help program. This is true, regardless of whether or not you meet any other eligibility requirements. If that is the case, you will receive a notice from the Centers for Medicare & Medicaid Services stating that you don’t need to apply for the Extra Help program.

The Benefits of the Extra Help Program 

Here are a few of the benefits you can expect from the program:

  • The program helps to lower the overall cost of your prescription drugs each month.
  • The program offers a Special Enrollment Period once each calendar quarter. This occurs during the initial nine months of the year you are enrolled in the Part D plan, or when you switch between plans.
  • The program helps eliminate any Part D late enrollment penalty fees you may face if you delayed your Part D enrollment.

The program pays for your Part D prescription drug plan premium up to the benchmark amount specified by your state.

Bottom Line

The Extra Help Program can be a great benefit to those who are enrolled in Medicare. It can help pay for the out-of-pocket expenses for prescription drugs that your current Medicare plan may not cover. While there are specific eligibility requirements for the program, if you are enrolled in Medicaid or if you receive SSI benefits, you automatically qualify.

Understanding the requirements for Medicare programs can be confusing. If you need assistance with guaranteeing you are receiving all the benefits you are entitled to, please fill out the form or give us a call anytime. We guarantee you that your licensed agent is focused first and foremost on providing you with information with zero pressure to enroll in a plan.