Do You Qualify for the Medicare Extra Help Program?

With costs for prescription drugs edging ever higher, it is difficult for seniors on limited incomes to pay for the medications they need. Added to Medicare coverage in 2006, Part D is meant to assist with prescription drug costs.

Medicare Part D helps, but it is not the whole story. Plan coverage is complex, with an initial coverage limit set by the government. When that is reached, the consumer enters into a “donut hole” period when they must pay full cost for prescription drugs until a new annual maximum amount is reached. Beneficiaries can end up responsible for thousands of dollars in drug costs.

According to the U.S. Department of Health and Human Services, an estimated quarter percent of Part D enrollees stop following their physician-prescribed regimen when they reach the donut hole to avoid the extra charges they can’t afford.

If you are a Medicare Part D participant with limited income, you may qualify for subsidy assistance through the federal Extra Help program. If so, you can save an estimated $4,000 per year.

What Medicare Extra Help Program Covers?

If you qualify, there are a couple of coverage types you can receive.

With full Extra Help coverage you:

• Receive coverage the entire year with no donut hole
• Don’t have a premium or deductible to pay
• Pay minimal costs for prescriptions

With partial Extra Help coverage you:

• Receive coverage the entire year with no donut hole
• Pay a reduced premium and deductible
• Pay up to 15% of the cost of prescription drugs

Who Qualifies for Extra Help?

The low-income subsidy under Medicare Part D requires that:

• You reside in the United States
• Your annual income must be no more than $17,655 for an individual or $23,895 for a married couple living together
• Your financial resources are no more than $13,640 as an individual or $27,250 for married couples who live together. These include bank accounts, stocks and bonds

There are instances when you may qualify for Extra Help even if you have a higher income. If you or your spouse support other family members living with you, have earnings from employment, or live in Alaska or Hawaii you may be able to enroll.

Extra Help application is through your local Social Security office. You’ll find more information about Medicare here.