{"id":12343,"date":"2020-06-23T13:00:13","date_gmt":"2020-06-23T17:00:13","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=12343"},"modified":"2025-12-31T14:41:04","modified_gmt":"2025-12-31T19:41:04","slug":"medicare-extra-help","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/medicare-extra-help\/","title":{"rendered":"Who qualifies for Medicare Extra Help? How to apply"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Even though <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-medicare\/\"><span style=\"font-weight: 400;\">Medicare<\/span><\/a><span style=\"font-weight: 400;\"> is federally funded, it isn&#8217;t free. Medicare costs vary from person to person, depending on various health and other factors. Monthly premiums, annual deductibles, and copayments can quickly add up. Pile monthly prescription drug costs on top of that, and it&#8217;s a pretty formidable expense. That&#8217;s where Extra Help comes in.\u00a0<\/span><\/p>\n<h2 id=\"what-is-medicare-extra-help\"><span style=\"font-weight: 400;\">What is Medicare Extra Help?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicare Extra Help is a federal subsidy that assists Medicare Part D enrollees in paying out-of-pocket costs associated with their Medicare prescription drug plan.\u00a0<\/span><\/p>\n<h2 id=\"what-does-medicare-extra-help-cover\"><span style=\"font-weight: 400;\">What does Medicare Extra Help cover?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Extra Help applies to <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-part-d-costs\/\"><span style=\"font-weight: 400;\">Medicare Part D expenses<\/span><\/a><span style=\"font-weight: 400;\"> only. It will not pay for Part A or Part B premiums, deductibles, or copays. T<\/span><span style=\"font-weight: 400;\">he level of Extra Help a beneficiary receives depends primarily on their annual income. Extra Help will fully or partially cover various Part D expenses, including the following.<\/span><\/p>\n<h3 id=\"premiums-and-deductibles\"><span style=\"font-weight: 400;\">Premiums and deductibles<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Most beneficiaries who qualify for full Extra Help won\u2019t pay a monthly premium or annual deductible. Those who qualify for partial Extra Help will pay a reduced monthly premium and deductible.<\/span><\/p>\n<h3 id=\"copayments\"><span style=\"font-weight: 400;\">Copayments<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Extra Help reduces copays on generic and brand-name drugs.<\/span><\/p>\n<h3 id=\"late-enrollment-penalties\"><span style=\"font-weight: 400;\">Late enrollment penalties<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Extra Help also provides a Special Enrollment Period for Part D plans once per calendar quarter (during the first nine months of the year) and eliminates Part D late enrollment penalties.<\/span><\/p>\n<h2 id=\"how-to-qualify-for-medicare-extra-help\"><span style=\"font-weight: 400;\">How to qualify for Medicare Extra Help<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Not everyone is <\/span><span style=\"font-weight: 400;\">eligible for Extra Help<\/span><span style=\"font-weight: 400;\">. <a href=\"https:\/\/www.medicare.gov\/basics\/costs\/help\/drug-costs\">To qualify<\/a>, Medicare beneficiaries must:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Reside in the United States and be enrolled in or eligible for a Part D prescription drug plan.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Meet the resource limits. <\/span><span style=\"font-weight: 400;\">&#8220;Resources&#8221; means bank accounts, real estate other than the primary residence, stocks, bonds, mutual funds, IRAs, and cash. This does not include primary residences, vehicles, personal possessions, life insurance policies, and burial expenses.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Meet the income limit for Medicare Extra Help. In this case, income does not include food stamps, housing assistance, home energy assistance, medical treatment and drugs, disaster assistance, tax credit payments, assistance from others, victims&#8217; compensation payments, scholarships, and education grants. Beneficiaries who earn more can still qualify if they:<\/span>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Support other family members who live with them<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Have other earnings from work<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"2\"><span style=\"font-weight: 400;\">Live in Alaska or Hawaii<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Additionally, anyone with Medicare who has already qualified for Medicaid, a Medicare Savings Program, or Supplemental Security Income (SSI) is <\/span><b>automatically eligible<\/b><span style=\"font-weight: 400;\"> and does not need to apply separately for Extra Help. If you happen to live in a state with no asset test (or asset limit) for the Medicare Savings Program, you might then qualify for Extra Help automatically, even if your resources are above the Extra Help asset limit. The <a href=\"https:\/\/www.ssa.gov\/medicare\/part-d-extra-help\">Social Security Administration<\/a> offers more information about eligibility and how to apply.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Minus the exceptions listed above, beneficiaries who exceed the resource and Medicare Extra Help income limits will <\/span><i><span style=\"font-weight: 400;\">not<\/span><\/i><span style=\"font-weight: 400;\"> qualify for Extra Help. It&#8217;s possible to apply and qualify for Extra Help before enrolling in <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-part-d-plans\/\"><span style=\"font-weight: 400;\">Medicare prescription drug coverage<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><span style=\"font-weight: 400;\">but the assistance won&#8217;t take effect until there&#8217;s a drug plan in place. In this instance, you will be automatically facilitated into a benchmark Part D plan if you do not already have one. If you would like to switch plans after you are automatically facilitated into one, you will have an opportunity to do so once your Part D coverage takes effect.<\/span><\/p>\n<h2 id=\"how-to-apply-for-extra-help\"><span style=\"font-weight: 400;\">How to apply for Extra Help<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Your go-to form is the Medicare Extra Help application (<\/span><a href=\"https:\/\/www.ssa.gov\/forms\/ssa-1020.html\"><span style=\"font-weight: 400;\">Form SSA-1020<\/span><\/a><span style=\"font-weight: 400;\">). You can <\/span><a href=\"https:\/\/secure.ssa.gov\/i1020\/start\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">apply online<\/span><\/a><span style=\"font-weight: 400;\"> or at any local Social Security office. It&#8217;s also possible to apply over the phone by calling the <\/span><span style=\"font-weight: 400;\">Social Security Administration&#8217;s toll-free number at 800-772-1213. <\/span><span style=\"font-weight: 400;\">(TTY users can call 800-325-0778 instead.)\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Social Security will review the application and inform the applicant of their eligibility. If they don&#8217;t have one already, the applicant must choose a Medicare prescription drug plan, or the Centers for Medicare and Medicaid Services will assign one automatically. The easiest way to enroll in a plan is through medicare.gov or by calling 1-800-MEDICARE.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">However, the Extra Help application isn&#8217;t the only necessary document. It&#8217;s important to keep other information on hand, suggests <\/span><a href=\"https:\/\/www.emedihealth.com\/experts\/urvish-patel\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Urvish Patel<\/span><\/a><span style=\"font-weight: 400;\">, MD, a research associate in Creighton University&#8217;s Department of Neurology. He recommends gathering information like:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Bank statements (checking, savings, and certificates of deposit)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Real estate documents<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Stock, bond, and mutual fund information<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">An amount of cash at home<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Typically, you will be charged a late enrollment penalty if you did not enroll in Part D when you first became eligible, and you did not have \u201ccreditable drug coverage,\u201d but any late enrollment penalty would be waived if you qualify for Extra Help.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Once an individual qualifies, they do not need to reapply each year as long as they continue to meet the eligibility requirements. However, you may be asked to complete a Review of Your Eligibility form. If circumstances change (e.g., they lose Medicaid eligibility or their income increases), they may need to <\/span><span style=\"font-weight: 400;\">reapply<\/span><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A caregiver or family member can apply for another person. Still, they must answer all the application questions and supply any required verification documents as if the beneficiary were doing it themselves.<\/span><\/p>\n<h2 id=\"other-ways-to-save-with-medicare\"><span style=\"font-weight: 400;\">Other ways to save with Medicare<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Anyone who&#8217;s received notice from Social Security that they don&#8217;t qualify for Extra Help might be discouraged, but there are other ways to save. Here are a few:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Choose a plan with the best formulary: <\/b><span style=\"font-weight: 400;\">Each Medicare Part D plan has its own <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-formulary\/\"><span style=\"font-weight: 400;\">drug formulary<\/span><\/a><span style=\"font-weight: 400;\">, which ranks drugs in a tier system. The higher the tier, the more expensive the drug. Before you enroll or change your Part D plan, look for a formulary that includes the majority (if not all) of your prescriptions at the lowest tier possible and with the fewest restrictions, such as prior approval or step therapy<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Use generic drugs instead of brand-name ones:<\/b><span style=\"font-weight: 400;\"> Generic drugs are just as good and only a fraction of the price, so they&#8217;re much easier on the wallet. Anyone considering making this switch should consult their healthcare provider first.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Compare prices: <\/b><span style=\"font-weight: 400;\">&#8220;Some pharmacies sell drugs cheaper than others,&#8221; says Dr. Patel. &#8220;And you can compare the price using smartphone apps.&#8221; Or, search for the desired medication on <\/span><a href=\"https:\/\/www.singlecare.com\/browse-prescriptions\"><span style=\"font-weight: 400;\">SingleCare&#8217;s website<\/span><\/a><span style=\"font-weight: 400;\"> for a list of the most affordable local prices.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Pharmaceutical assistance programs:<\/b><span style=\"font-weight: 400;\"> <a href=\"http:\/\/Medicare.gov\">Medicare.gov<\/a> has databases for <\/span><span style=\"font-weight: 400;\">pharmaceutical companies<\/span><span style=\"font-weight: 400;\"> and <\/span><span style=\"font-weight: 400;\">states<\/span><span style=\"font-weight: 400;\"> that have programs that help pay for prescription drugs. &#8220;Some employers may also have assistance programs for employees who need life-saving medications,&#8221; Dr. Patel says.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Use SingleCare coupons:<\/b> <a href=\"https:\/\/www.singlecare.com\/blog\/can-i-use-singlecare-and-medicare\/\"><span style=\"font-weight: 400;\">SingleCare is available to Medicare beneficiaries<\/span><\/a><span style=\"font-weight: 400;\"> and individuals who qualify for Extra Help. With coupons worth up to 80% off and applicable at pharmacies nationwide, it&#8217;s a great way to help reduce Part D out-of-pocket costs.<\/span><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><a href=\"https:\/\/www.singlecare.com\/es\/recursos\/medicare-extra-help\"><span style=\"font-weight: 400;\">Lea este art\u00edculo en espa\u00f1ol aqu\u00ed.<\/span><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Even though Medicare is federally funded, it isn&#8217;t free. Medicare costs vary from person to person, depending on various health and other factors. Monthly premiums, annual deductibles, and copayments can quickly add up. Pile monthly prescription drug costs on top of that, and it&#8217;s a pretty formidable expense. That&#8217;s where Extra Help comes in.\u00a0 What [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":627681,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[608,691,15,4350],"coauthors":[8861],"class_list":["post-12343","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-health-insurance","tag-healthcare-costs","tag-medicare","tag-prescription-savings","franchise-healthcare-defined","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Who qualifies for Medicare Extra Help? How to apply<\/title>\n<meta name=\"description\" content=\"The level of Extra Help that eligible Part D consumers receive varies. 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