All Dual-Eligible Special Needs Plans (D-SNPs) include prescription drug coverage. If you’re dual eligible (enrolled in both Medicare and Medicaid), you automatically qualify for Extra Help. Extra Help is a federal program that helps pay for out-of-pocket costs related to Medicare prescription drug coverage (Part D), including premiums, deductibles, and copayments. Extra Help is also known as the Medicare Part D Low-Income Subsidy (LIS). The Social Security Administration and the Centers for Medicare & Medicaid Services work together to provide this benefit.
If you are not enrolled in a Dual-Eligible Special Needs Plan but are part of a Medicare Savings Program, you are also automatically enrolled in Extra Help. You are also automatically enrolled if you receive Supplemental Security Income.
Note: Some people who are not automatically eligible for Extra Help can apply and receive this assistance! Keep reading to find out how.
Most dual-eligible beneficiaries who qualify for Extra Help pay:
In addition to the savings from Extra Help, many Dual-Eligible Special Needs Plans include a monthly or quarterly allowance to purchase many over-the-counter healthcare-related products, such as vitamins, bandages, cold medicine, and much more.
All of these benefits could help lower your out-of-pocket prescription drug costs. According to the Social Security Administration, Extra Help is worth about $5,000 a year.
You may also qualify for Extra Help if you live in the United States, are enrolled in Medicare, and your savings and investments are worth less than $30,000 (as a couple) or $15,000 (as an individual). However, these standards for eligibility do not auto-enroll you in Extra Help. If you do not automatically qualify for Extra Help, you must apply through the Social Security Administration. Applying is free and you can apply every year. The application will ask for information about your financial assets and living situation.
The Social Security Administration believes that many people are eligible for Extra Help and don’t know it, so we do recommend applying if you have any doubt about whether you may be eligible.
The exact numbers for the resource limit that makes you eligible for Extra Help can change each year and it’s also important to know what is considered in that eligibility decision and what does not count.
Counts toward the Resource Limit:
Does NOT count toward the Resource Limit:
Some other resources are not counted for nine months after you receive them, like housing assistance, some tax refunds, and more.
The complex details of how to calculate your resources for Extra Help are another reason that we recommend applying if you have any idea that you might be eligible. The Social Security Administration can assist you in determining the exact details of your application so that you don’t miss out on potentially $5,000 a year.
Once you have qualified for Extra Help, any changes to your eligibility will be communicated by mail in late September each year. Your eligibility for this assistance can change based on your income and living situation.
The notification in September will give you plenty of time to review your options before the new year and potentially change your Medicare plan during the Medicare Annual Election Period (Oct. 15 – Dec. 7). If you no longer qualify for Extra Help, enrolling in a Prescription Drug Plan (Part D) or Medicare Advantage Plan with prescription drug coverage may help you in lowering your costs.
Medicare enrollment is typically only available during very specific enrollment periods each year, but in addition to helping pay out-of-pocket Part D costs, Extra Help offers a quarterly Special Enrollment Period where dual-eligible beneficiaries can change their Part D coverage once January-March, April-July, and July-September. That eliminates having to wait until the Annual Election Period that runs October 15 through December 7 to get Extra Help. However, you can also make changes to your coverage during the Annual Election Period. Being eligible for Extra Help also eliminates the Part D late enrollment penalty.
To find a Medicare plan that takes advantage of your Extra Help benefits, call and receive your no-cost consultation at 1-855-918-3272 / TTY 711, Mon - Thurs 8am - 11pm EST and Friday 8am - 9pm EST. Our licensed insurance agents will assist you in comparing plans in your area, checking the cost and availability of your prescriptions, and enrolling in the plan of your choice. Don’t forget to ask about over-the-counter benefits that can save you money on your healthcare-related purchases!