Prescription drugs can be a financial burden for many individuals. The Extra Help program can help many low-income Medicare beneficiaries reduce their out-of-pocket prescription drug costs. As an agent, it is necessary to understand the ins and outs of this program to help your clients. Read more below to make sure you can help your clients get the savings they need. Even if you are familiar with the program, find out how more people can qualify in 2024 due the Inflation Reduction Act.
What is Medicare Part D Extra Help?
Medicare Extra Help, also referred to as Part D Low Income Subsidy (LIS), is a federal program designed to assist individuals with limited income and resources in paying for their prescription drugs. This program can significantly reduce the Part D cost of medications, insurance premiums, deductibles, and co-payments for those who qualify. It also eliminates the Part D penalty when enrolled in the program.
Benefits of Extra Help
The benefits of Extra Help are substantial and can add up to thousands of dollars per year. They include:
- Lower Prescription Costs: Reduced prices for prescription drugs, which can lead to significant savings.
- Reduced Premiums and Deductibles: Assistance with Medicare Part D premiums, deductibles, and co-payments.
- No Coverage Gap: Elimination of the Medicare Part D coverage gap, also known as the “donut hole.”
- No Late Enrollment Penalty: If you qualify for Extra Help and enroll in a Medicare Part D plan, you won’t have to pay a late enrollment penalty, even if you sign up late.
Who is Eligible for Extra Help?
Eligibility for Extra Help is based on income and resources. Generally, individuals with an income below 150% of the Federal Poverty Limit (FPL) and limited resources are eligible. The Social Security Administration (SSA) is responsible for determining eligibility each year.
| Income limit: | Resource limit: | |
| Individual | $21,870 | $16,600 |
|---|---|---|
| Married Couple | $29,580 | $33,240 |
Medicare Beneficiaries will get Extra Help automatically if they receive:
- Full Medicaid coverage
- Help from your state paying your Part B premiums (from a Medicare Savings Program)
- Supplemental Security Income (SSI) benefits from Social Security
They will receive a letter about their Extra Help in these circumstance. It tells them how much they’ll pay, and their enrollment into a new Medicare drug plan, if they don’t have one already. If they are automatically enrolled in a plan they can make a change using a Special Enrollment Period.
How to Apply for Extra Help?
Applying for Extra Help is straightforward. Beneficiaries can apply online HERE through the Social Security Administration’s website, over the phone, or in person at a local Social Security office. Agents should familiarize themselves with the process so they can assist clients when needed.
Navigating Medicare Part D and Extra Help
Understanding the nuances of Medicare Part D and the Extra Help program can be complex. Here are a few tips:
- Annual Review: Medicare Part D plans and benefits can change annually. It’s important to help them review their plan each year to ensure it still meets their needs.
- Special Enrollment Period: Beneficiaries receiving Extra Help have a Special Enrollment Period to switch plans once per quarter for quarter 1, quarter 2, and quarter 3. The also have a special enrollment period when they first become eligible or have a change in the level of assistance.
Conclusion
Medicare Part D Extra Help is a valuable resource for those struggling with the costs of prescription drugs. By reducing financial barriers, it ensures that more individuals have access to the medications they need. Agents can help their clients by making sure they understand the program and can help they qualify and enroll.
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