SAVVY SENIOR – How to get ‘extra help’ paying for prescriptions

Dear Savvy Senior,

Does Medicare offer any financial assistance programs to help seniors with their medication costs? I recently enrolled in a Medicare drug plan, but I take some expensive medications that have high out-of-pocket costs and need some help.

Living on a Shoestring

Dear Living,

Yes, there’s a low-income subsidy program called ‘Extra Help’ that assists Medicare beneficiaries on a tight budget by paying for their monthly premiums, annual deductibles, and co-payments related to their Medicare (Part D) prescription drug coverage. 

And, thanks to the Inflation Reduction Act that was passed by Congress and signed into law in late 2022, this program has expanded and gotten easier to qualify for in 2024. Even if you’ve applied and didn’t qualify before, you may be eligible now.

The Extra Help benefit is estimated to be worth about $5,300 per year. Currently over 13 million people are receiving this subsidy, but there’s around 3 million more who may qualify for it but don’t realize it. 

The amount of financial assistance you would receive depends on your income and assets. If you qualify, you’ll pay no premium or deductible (unless receiving a partial subsidy), and no more than $4.50 for each generic drug or $11.20 for each brand-name drug your plan covers in 2024.

To get the subsidy, your resources must be limited to $17,220 or $34,360 for married couples living together. Bank accounts, stocks, bonds, mutual funds and IRAs count as assets, but your home, vehicle, personal belongings, life insurance and burial plots do not.

Also, your annual income must be limited to $22,590 for an individual or $30,660 for married couples. If you support a family member who lives with you, or you live in Alaska or Hawaii, your income can be higher. In addition, the government won’t count any money if you receive help for household expenses like food, rent, mortgage payments, utilities and property taxes.

How to Apply

There are three ways to see if you qualify and apply for Extra Help: online at SSA.gov/medicare/part-d-extra-help; by calling Social Security at 800-772-1213; or by visiting your local Social Security office.

The application form is easy to complete, but you will need your Social Security number and information about your bank balances, pensions and investments. Social Security will review your application and send you a letter within a few weeks letting you know whether you qualify.

If you don’t qualify for Extra Help, you may still be able to get help from a state pharmacy assistance program or a patient assistance program. Visit NeedyMeds.org to search for these programs. 

Other Medicare Assistance

If you’re eligible for Extra Help, you may also qualify for help with your other Medicare expenses through your state’s Medicare Savings Program.

State Medicaid programs partner with the federal government, so income and asset qualifications vary depending on where you live. Medicare Savings Programs will pay your entire Medicare Part B premium each month. And in some cases, they may also pay your Medicare deductibles, coinsurance and copayments, depending on your income level. To find out if you qualify, contact your state Medicaid office. 

You can also get help through your State Health Insurance Assistance Program (SHIP), which provides free Medicare counseling in person or over the phone. Visit ShipHelp.org or call 877-839-2675 to locate a counselor in your area.