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Extra Help with Medicare Part D

By: Craig Sturgill

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Many people on Medicare struggle with the cost of their prescription drugs. Extra Help is another name for Low-Income subsidy. This program assists those with limited income pay for drug costs.

You can get Extra Help even if your income and assets are above the limits stated above. There are different levels of Extra Help. Each level is dependent on your income and resources.

Full Extra Help: This is the complete Extra Help and pays for almost all of your prescription drug costs. In many cases, this includes the premium of your Part D plan or the drug portion of your Medicare Advantage plan.

Partial Extra Help: This Extra Help pays a percentage of your drug costs. If you have the Partial Extra Help, you will pay a smaller deductible if your plan has one and pay the lower of the plan copay or 15% of the cost of your drug.

Partial Extra Help has into four categories. Regardless of which one you qualify for, you will pay the same deductible is applicable and costs for your prescriptions:

  1. 100% Partial Extra Help: Your plan's premium is reduced by 100% of your state's allowable amount.
  2. 75% Partial Extra Help: Your plan's premium is reduced by 75% of your state's allowable amount.
  3. 50% Partial Extra Help: Your plan's premium is reduced by 50% of your state's allowable amount.
  4. 25% Partial Extra Help: Your plan's premium is reduced by 25% of your state's allowable amount.

How Much Will Extra Help Pay?

Your Extra Help payment will vary depending on your income and resources. Full Extra Help pays for almost all your premium, deductible, and drug costs. In contrast, partial Extra Help can reduce your premium, drug costs, and deductible.

Extra Help and the Coverage Gap

When you qualify for Extra Help, you won’t have to worry about falling into the coverage gap phase of Part D.

The "donut hole" is another name for this period. The coverage gap is when you pay a higher percentage of your pharmaceutical expenses while receiving Medicare than getting Extra Help.

Extra Help for Your Prescription Drug Costs

On the Social Security website, you may fill out Form SSA-1020 to apply for Extra Help. You can also call Social Security to apply over the phone or go to your local Social Security office to apply in person.

What Information is Needed When I Fill Out My Application for Extra Help?

When you fill out your Extra Help application, you will need to provide Social Security with proof of your income and resources. This proof could include recent tax returns, bank statements, and investment information. If you're not sure what documents to bring, call Social Security or visit your local office.

Remember, you may be able to get Extra Help even if your income is higher than the limits listed above. And suppose Extra Help reduces your premium, drug costs, or deductible below the thresholds for Part D's Low-Income subsidy. In that case, you'll automatically qualify for that subsidy.

What is a Resource Limit?

A resource limit is the total value of your assets that can be used to pay for Extra Help. This includes cash, checking, savings accounts, stocks, bonds, and other investments.

The resource limit excludes the value of your home, car, burial expenses, interest on burial policies, and personal belongings. However, Social Security doesn't count all of your assets equally. For example, they will count one dollar of cash as worth more than one dollar of an annuity or life insurance policy.

FAQs

Do I Qualify?
You could qualify for Extra Help if you have Medicare and limited income and resources. Check with your social security office or speak with a licensed agent to see if you are eligible.

What is the Extra Help Program?
The Extra Help program provides financial assistance to people with limited income and resources enrolled in a Medicare drug plan. Extra Help can lower your premium, deductibles, and copays.

What Kind of Documents Do I Need to Provide?
When you fill out your Extra Help application, you will need to provide Social Security with proof of your income and resources. This could include recent tax returns, bank statements, and investment information.

What is the Resource Limit?
The resource limit is the total value of your assets that can be used to pay for Extra Help. This includes cash, checking, savings accounts, stocks, bonds, and other investments.


Craig Strugill is currently the co-founder and chief strategy officer at Excel Impact. He is well-known within the insurance industry for his innovative thinking and strategic approach, specializing in lead generation and internet advertising for multiple products including Medicare, Health, Home, Auto, and Final Expense life insurance. Mr. Sturgill is a leader in entrepreneurship, having started his own business while still in high school and growing not just one, but three full-fledged companies by the ripe age of 27.


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