Medicare Part D Extra Help: Lowering Your Prescription Drug Costs

If you are enrolled in Medicare and struggling with the cost of prescription drugs, the Medicare Part D Extra Help program might be exactly what you need. Also known as the Low-Income Subsidy (LIS), this federal program is designed to assist people with limited income and resources in paying for their Medicare prescription drug plan costs. This includes premiums, deductibles, and coinsurance.

The reality of healthcare is that prescription medications can quickly become a significant financial burden. The Extra Help program exists to ensure that you don't have to choose between your necessary medications and other essential living expenses. It is estimated that this program is worth about $5,300 per year to the average person who qualifies.

To understand how Extra Help fits into your overall Medicare strategy, it is important to remember the two paths of Medicare. The first path is Traditional Medicare (Parts A and B), which you can pair with a Medicare Supplement (Medigap) plan to cover the gaps, and a standalone Part D plan for your prescriptions. The second path is Medicare Advantage (Part C), which often bundles your medical and prescription drug coverage together. Regardless of which path you choose, if you have Medicare prescription drug coverage, you may be eligible for Extra Help.

Qualifying for Extra Help depends on your income and resources. Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs). However, your home, your car, household items, burial plots, up to $1,500 for burial expenses (per person), and life insurance policies do not count as resources. The income and resource limits can change each year, so it is crucial to check the current thresholds.

If you qualify for Extra Help, you will receive assistance in several ways. First, the program will pay for some or all of your Part D monthly premium. Second, it will help cover your annual deductible. Third, it will significantly lower the copayments or coinsurance you pay when you fill a prescription. Finally, if you qualify for Extra Help, you will not be subject to the Part D late enrollment penalty, even if you delayed signing up for prescription drug coverage when you were first eligible.

Some people automatically qualify for Extra Help and do not need to apply. You automatically qualify if you have full Medicaid coverage, if you get help from your state paying your Part B premiums (through a Medicare Savings Program), or if you receive Supplemental Security Income (SSI) benefits. If you fall into one of these categories, Medicare will send you a notice confirming your eligibility.

If you do not automatically qualify, you can apply for Extra Help through the Social Security Administration. The application process is straightforward, and you can apply online, over the phone, or in person at your local Social Security office. When you apply, Social Security will review your income and resources to determine your eligibility.

Navigating Medicare and prescription drug costs doesn't have to be a solo mission. We are here to walk you through every option and help you understand if you qualify for programs like Extra Help. We sit on your side of the table, providing straight answers with no surprises. Let us help you protect what you've earned while ensuring you get the coverage you need.