Getting Extra Help

If you meet certain income and resource limits, you may qualify for Extra Help. This program helps pay for your Medicare drug coverage, such as plan premiums, deductibles, and costs when you fill your prescriptions, called copays or coinsurance.

How much would I pay if I qualify for Extra Help?

Plan premiums & deductibles: Depending on your income level, you may pay less or pay nothing for your plan premium and yearly deductible (an amount you have to pay before your plan starts to pay.)

Copays & coinsurance: In 2020, drug costs are no more than:

• $3.60 for each generic drug
• $8.95 for each brand-name covered drug
• 
  

In 2021, these costs will be no more than $3.70 for each generic and $9.20 for each brand-name covered drug.

Do I qualify for Extra Help?

In 2020, you may qualify if you have up to $19,140 in yearly income ($25,860 for a married couple) and up to $14,610 in resources ($29,160 for a married couple).

Resources that count to see if you qualify:

• Money in a checking or savings account
• Stocks
• Bonds

Resources that don't count to see if you qualify:

• 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

How do I get Extra Help?

Some people automatically qualify for Extra Help. You'll get the Extra Help program if you have Medicare and get any of the following:

• Full Medicaid coverage
• Help from your state Medicaid program paying your Part B premiums (from a Medicare Savings Program)
• Supplemental Security Income (SSI) benefits

If you don’t automatically qualify, you can apply for Extra Help at any time.

Apply for Extra Help

You'll get a letter if you qualify:

• If you automatically qualify: You’ll get a letter on yellow paper.
• If you apply for Extra Help: You’ll get a letter on green paper.

If you don't qualify for Extra Help, your state may have programs that can help with drug coverage costs. Contact your Medicaid office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.

Things to know after you qualify for Extra Help

How long will I get Extra Help?

Once you qualify for the Extra Help program, you'll have it as long as you meet the year's income and resource limits. Even if you automatically qualify this year, you may not qualify for Extra Help next year. Changes in your income or resources may cause you to no longer to qualify.

How will I know if I no longer qualify for Extra Help?

• If you got Extra Help, but no longer automatically qualify for next year: You’ll get a letter (on grey paper) by the end of September. If you get this notice, you may still qualify for help with prescription costs, but you need to apply to find out.
• If your copays change next year: You'll get a notice (on orange paper) in the mail in early October with the new amounts.
• If you don't get a notice from Medicare: You'll get the same level of Extra Help that you got for this year.

What do I do if I think my drug costs are wrong?

If you're not sure if you're paying the right amount, call your drug plan. Your plan may ask you to give information to help them check the level of Extra Help you should get.

Can I get money back if I've been paying too much?

If you paid for prescriptions since you qualified for Extra Help and you aren't enrolled in Medicare drug coverage, you may be able to get some money back. Keep receipts with your prescription drug prices, and call your plan. Or, you can contact Medicare's Limited Income Newly Eligible Transition (NET) Program at 1-800-783-1307 for more information (TTY: 711).