Understanding Medicare Part D Extra Help: A Friendly Guide

How Extra Help Can Save You Money on Prescription Drug Costs

Navigating Medicare can feel overwhelming, but I’m here to help make it easier for you. If you’re eligible for Medicare, you might have heard about a program called “Extra Help”—also known as Low Income Subsidy (LIS)—that could significantly reduce your prescription drug costs. Let’s walk through what you need to know so you can feel confident about your choices.

What Is Extra Help for Medicare Part D?

Extra Help is a federal program designed to help Medicare beneficiaries save money specifically on Part D prescription drug costs. It’s a great option if you’re worried about affording your medications.

• You can only use it for Medicare Part D (the part that covers prescription drugs).
• The program is administered by the Social Security Administration, which also determines your eligibility.
• To qualify, you’ll need to meet certain income and resource thresholds, and these limits can change every year.
• The Social Security Administration handles the application process and can answer questions about your specific situation.

Who Qualifies for Extra Help?

To get Extra Help, you need to meet these basic requirements:

• Have both Medicare Part A (hospital insurance) and Part B (medical insurance).
• Live in one of the 50 states or the District of Columbia.
• Meet the yearly income and resource limits set by the government.

Levels of Extra Help

There are three levels of Extra Help, depending on your income and resources. Each level offers different savings, but all of them can lower your prescription copays and eliminate or reduce your Part D premiums and deductibles.

Other Benefits

With Extra Help, you may be able to get a three-month supply of your generic or brand-name drugs for a single copay, either at your local pharmacy or through home delivery—if your state allows it. The copay you pay for these three months is the same as what you’d pay for one month’s supply.

Part D Late Enrollment Penalty Relief

If you delayed enrolling in Part D and have a late enrollment penalty, Extra Help might cover that penalty for you. Just remember, once you’re enrolled, you need to stay enrolled without a break of 63 days or more to keep this benefit. If you don’t receive a letter about the penalty amount, call your advisor or if you do not have one then you can contact your plan’s member services for clarification.

Special Enrollment Periods (SEP)

Life changes happen, and you may qualify for a Special Enrollment Period if you’re removed from Extra Help, become newly eligible, or gain new assistance this would trigger the special enrollment. This gives you a chance to adjust your coverage without waiting for the regular enrollment period.

How I Can Help

Understanding these programs can be confusing, but you’re not alone. I’m here to answer your questions and help you figure out if you qualify for Extra Help. Together, we’ll make sure you get the support you need to manage your prescription costs with confidence and peace of mind.

If you have questions or want guidance through the application process, don’t hesitate to reach out. I’m here to help you every step of the way.