Qualifying for Extra Help
Medicare Extra Help is an assistance program for prescription drug expenses. It’s managed by the U.S. federal government, and it subsidizes Medicare beneficiaries who have, or need, Part D coverage and who meet the income and asset limits set by the Social Security Administration.
If you qualify for the Medicare Extra Help program, it can help you with many financial issues concerning your Medicare Part D coverage, such as the following:
- It eliminates a Medicare Part D late enrollment penalty if you don’t enroll during a specially designated enrollment period. This means that you can enroll in Part D coverage after you become eligible for Extra Help without paying a penalty.
- It lowers your out-of-pocket costs for prescription drug copayments.
- It covers your monthly premium for your prescription drug (Part D) plan.
- It covers your annual Part D deductible totally or partially, depending on the type of coverage you have.
- It eliminates the Part D coverage gap, also known as the donut hole. This means you won’t pay more for prescription drugs if you go over your annual spending limit.
Because the Medicare Extra Help program can save you around $5,000.00 in prescription drug costs every year, it can be worth your time to see if you qualify. This article shows you what Medicare’s Extra Help program qualification requirements are.
What are the qualification requirements for Medicare Extra Help?
You may automatically qualify for Extra Help if you are enrolled in, or eligible for, Medicaid or any of these Medicare Savings Programs:
- The Qualified Medicare Beneficiary Program
- The Specified Low-Income Medicare Beneficiary Program
- The Qualifying Individual Program
Otherwise, to qualify for the Extra Help subsidy, you must first be enrolled in, or eligible for, Original Medicare Part A (hospital insurance) and Part B (medical insurance).
Original Medicare enrollment is available for people who have reached the age of 65. Those who are receiving Social Security retirement or Railroad Retirement Board benefits when they turn 65 are automatically enrolled in Original Medicare Parts A and B.
Medicare Extra Help may also be available for people who are younger than 65. This is the case if they have been receiving Social Security Disability benefits for 24 months, have End-Stage Renal Disease, or Amyotrophic Lateral Sclerosis, and are ready to enroll in Original Medicare.
Secondly, you must also meet the income and asset level qualifications to qualify for the Medicare Extra Help program. These limits are based on the federal poverty levels according to U.S. government standards. The income and asset limits are reevaluated and changed every year, and they are set according to the cost of living and the average income for the year in each state.
You may qualify for full or partial Extra Help benefits if you meet the income limit for the current year.
The Medicare Extra Help income limits for 2022 are the following:
- To receive full Extra Help benefits as a single person you must not exceed $8,400.00 in total resources or $20,625.00 in annual income.
- To receive full Extra Help benefits as a married person you must not exceed $12,600.00 in total resources or $27,705.00 in joint annual income.
- To receive partial Extra Help benefits as a single person you must not exceed $14,010.00 in resources or $20,625.00 in annual income.
- To receive partial Extra Help benefits as a married person your resources shouldn’t exceed $27,950.00 or your annual income shouldn’t exceed $27,705.00
The following are counted as resources:
- Savings accounts
- Real estate – with the exception of your primary residence
If you lose your eligibility for automatic enrollment in Extra Help because you are no longer eligible for any of the programs mentioned above, you can still apply for the Extra Help program.
You can apply for the Medicare Extra Help program through the Social Security Administration (SSA) or the Centers for Medicare & Medicaid Services (CMS). You can do this at either of the administration’s official websites or in person at a local SSA or CMS office.