Extra Help from Medicare


Extra Help was created to assist people with limited incomes pay for Medicare Part D coverage. If you qualify, you’ll pay less for monthly premiums and have reduced or no copayments for prescription drugs. In addition, people with Medicare who get Extra Help paying Part D costs won't enter the coverage gap and won't pay a late enrollment penalty.

If you receive Extra Help, your Blue MedicareRx (PDP) benefits will stay the same as benefits for someone without Extra Help.

Who is eligible for Extra Help?

This program is automatically available to some people. Other people must meet certain requirements for income and financial resources.

You automatically qualify for Extra Help if you have one of the following:

  • Both Medicare and Medicaid.
  • Help from Medicaid paying your Medicare Part B premiums (for instance, you belong to a Medicare Savings Program).
  • Both Medicare and Supplemental Security Income (SSI) benefits.

You should apply for Extra Help if you have the following income and resources:

Status 2018 Income Resources
SingleLess than $18,210 Less than $14,100
Married (living with spouse)Less than $24,690Less than $28,150

Notes

  • Resources include your savings and stocks, but not your home or car or the value of any life insurance you may have.
  • The above amounts are for 2018 and may change in 2019. If your income and resources are slightly higher, you should still apply.

How to apply for Extra Help

To see if you qualify, choose one of the following methods:

  • Call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.
  • Call your State Medicaid Office or the Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778.
  • Apply on the Social Security Administration’s website.
  • Visit your local Social Security office.

How to complete the Extra Help application form

The Social Security Administration encourages you to get help from family members, caregivers, and other third parties.

Get ready by following these steps:

  • Identify the major assets you own alone, with your spouse or with someone else, but do not include your home, vehicles, burial plots, or personal possessions.
  • Review all your income.
  • Gather your records in advance to save time.

The records you will need are:

  • Statements that show your account balances at banks, credit unions, or other financial institutions.
  • Investment statements.
  • Life insurance policy statements.
  • Stock certificates.
  • Tax returns.
  • Pension award letters.
  • Payroll slips.

What if I’ve been told I no longer qualify for Extra Help?

You may still qualify for Extra Help, but you must re-apply to find out. You have the right to appeal the decision. To file an appeal, you will need to fill out a form (PDF) from Social Security.

How often do I need to re-apply for Extra Help?

Social Security will review your eligibility every year. You do not need to re-apply unless you are notified that you no longer qualify for Extra Help.

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