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Vol. 14, Issue 7 – April 6, 2015

How can I qualify for Extra Help?

Dear Marci,

I have some chronic health care conditions, and have to take several prescription drugs to manage them. I spend a lot of money on Medicare prescription drug copays each month, and I’m struggling to keep up with these costs. My friend told me that I should see if I can apply for the Extra Help program. What is the Extra Help program?

–  Barbara (San Francisco, CA)

Dear Barbara,

Extra Help is a federal program that helps people with limited incomes to pay the costs associated with Medicare prescription drug coverage (Medicare Part D). Extra Help is administered by the Social Security Administration. To qualify, you must meet income and asset guidelines that are determined by the federal government each year. If you are single in 2015, your monthly income must be below $1,471 ($1,991 for couples), and your assets must be up to $13,640 ($27,250 for couples) in order to qualify for Extra Help.

In order to have Extra Help, you must get your prescription drug coverage through Medicare Part D. You can get this coverage through a stand-alone Part D plan that works with Original Medicare, or through a Medicare Advantage plan that includes prescription drug coverage. Extra Help does not work with other forms of prescription drug coverage, such as coverage from an employer. If you do not have a Part D plan, Extra Help gives you a Special Enrollment Period to enroll in a Part D plan outside of typical enrollment periods.

Depending on your income and assets, you may qualify for either full or partial Extra Help. With either program, you will never have to pay the full cost of your drugs as long as you take medications that are on your plan’s formulary—its list of covered drugs—and you buy them at a pharmacy in your plan’s network. You also can use a mail-order pharmacy with Extra Help. Extra Help can also assist with your monthly Part D premium and annual deductibles.

Apply for Extra Help through the Social Security Administration. You can call the National Hotline at 800-772-1213, or visit your local Social Security office. You also can apply online at http://www.ssa.gov/medicare/prescriptionhelp/.

Know that some people may get Extra Help automatically; people who have a Medicare Savings Program, receive Supplemental Security Income (SSI), or have Medicaid all receive Extra Help.

If you do not qualify for Extra Help, your state may have a State Pharmaceutical Assistance Program (SPAP) that can assist with prescription drug costs. Eligibility requirements and program benefits may vary, depending on the program. Contact your local State Health Insurance Assistance Program (SHIP) to see if there is one available in your state. To find your SHIP, visit www.shiptacenter.org or call 877-839-2675.

Click here to read more about Extra Help and to learn about whether you may qualify for Extra Help. Click here to learn about other programs and ways that can help lower your prescription drug costs.

-Marci

Health Tip
For some, the start of Spring may mean the start of springtime allergies. Springtime allergies can cause sneezing, watery eyes, runny noses, or itchy eyes or throat. If you experience such allergies, it is important to know what triggers them so that you can take steps to protect yourself. Some tips for reducing the side effects of allergies:

  • Monitor pollen and mold counts, and stay indoors at times when the pollen count is the highest.
  • Keep your windows, doors, and car windows shut as much as possible during allergy season to keep pollen out.
  • Speak with your doctor if you have severe allergies, and discuss allergy medications if necessary.

To read about protecting yourself from Spring allergies, click here.

Need to Know
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This unique resource provides professionals with a clear path to learning Medicare through a Core Curriculum—four levels of Medicare instruction designed to build on information learned as you progress through each level. Medicare Rights University also offers a Special Topics section which provides an in-depth look at subjects not covered in the Core Curriculum, such as Medicare’s coverage of durable medical equipment and Medicare from a policy perspective.

Check out Medicare Rights University today by going online and visiting www.medicarerightsuniversity.org.

Dear Marci is a biweekly e-newsletter designed to keep you — people with Medicare, social workers, health care providers and other professionals — in the loop about health care benefits, rights and options for older Americans and people with disabilities.

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