'Extra Help' Program Helps with Medication Costs
Are there any special Medicare programs that help with medication costs? My 74-year-old mother, who lives primarily on her Social Security, takes several high-priced drugs that sap her income even with her Medicare drug plan.
Yes, there is a low-income subsidy program called Extra Help that can assist seniors on a tight budget with paying for their premiums, deductible and co-payments in their Medicare (Part D) prescription drug plan.
Currently, around 10 million people are receiving this subsidy, but another two million may qualify and not even realize it. They are missing out on hundreds, maybe thousands, of dollars in savings each year.
Changes in the law make it easier than ever to qualify for the Extra Help program. Even if your mom applied but was not qualified in the past, she may be eligible now. The amount of additional assistance she would receive depends on her income and assets. If she qualifies for help, she will pay no more than $3.35 for a generic drug and $8.35 for a brand-name drug in 2018.
To qualify to receive the subsidy, your mom's assets cannot exceed $14,100 (or $28,150 for married couples living together). Assets, for the purposes of qualifying for this program, include bank accounts, stocks and bonds. Homes, vehicles, personal belongings, life insurance and burial plots are not considered assets under the program.
In addition, your mom's monthly income cannot exceed $1,538 (or $2,078 for married couples). If your mom supports a family member who lives with her, or lives in Alaska or Hawaii, her income can be higher. The government will not include as income any funds that your mom receives for household expenses like food, rent, mortgage payments, utilities and property taxes.
There are three ways to apply for Extra Help: online at SSA.gov/prescriptionhelp; by calling Social Security at 800-772-1213; or by visiting a local Social Security office.
The application form is easy to complete, but you will need your mom's Social Security number and information about her bank account balances, pensions and investments. Social Security will review her application and send her a letter within a few weeks letting her know whether she qualifies.
If your mom doesn't qualify for Extra Help, she may still be able to get help from a state pharmacy assistance program or a patient assistance program. Visit the National Council on Aging's Benefits Check Up website to search for these programs.
If your mom is eligible for Extra Help, she may also qualify for help with her other Medicare expenses through her state's Medicare Savings Program.
State Medicaid programs partner with the federal government, therefore income and asset qualifications vary depending on where she lives. Medicare Savings Programs may pay her entire Medicare Part B premium each month. Some also pay for Part B coinsurance and copayments, depending on her income. Contact your mom's state Medicaid office to determine if she qualifies for benefits in her state.
She can also get help through her State Health Insurance Assistance Program (SHIP), which provides free one-on-one Medicare counseling in person or over the phone. To locate a SHIP counselor in your area, visit the SHIP National Technical Assistance Center website or call the eldercare locator at 800-677-1116.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
Yes, there is a low-income subsidy program called Extra Help that can assist seniors on a tight budget with paying for their premiums, deductible and co-payments in their Medicare (Part D) prescription drug plan.
Currently, around 10 million people are receiving this subsidy, but another two million may qualify and not even realize it. They are missing out on hundreds, maybe thousands, of dollars in savings each year.
Changes in the law make it easier than ever to qualify for the Extra Help program. Even if your mom applied but was not qualified in the past, she may be eligible now. The amount of additional assistance she would receive depends on her income and assets. If she qualifies for help, she will pay no more than $3.35 for a generic drug and $8.35 for a brand-name drug in 2018.
To qualify to receive the subsidy, your mom's assets cannot exceed $14,100 (or $28,150 for married couples living together). Assets, for the purposes of qualifying for this program, include bank accounts, stocks and bonds. Homes, vehicles, personal belongings, life insurance and burial plots are not considered assets under the program.
In addition, your mom's monthly income cannot exceed $1,538 (or $2,078 for married couples). If your mom supports a family member who lives with her, or lives in Alaska or Hawaii, her income can be higher. The government will not include as income any funds that your mom receives for household expenses like food, rent, mortgage payments, utilities and property taxes.
How To Apply
There are three ways to apply for Extra Help: online at SSA.gov/prescriptionhelp; by calling Social Security at 800-772-1213; or by visiting a local Social Security office.
The application form is easy to complete, but you will need your mom's Social Security number and information about her bank account balances, pensions and investments. Social Security will review her application and send her a letter within a few weeks letting her know whether she qualifies.
If your mom doesn't qualify for Extra Help, she may still be able to get help from a state pharmacy assistance program or a patient assistance program. Visit the National Council on Aging's Benefits Check Up website to search for these programs.
Other Medicare Assistance
If your mom is eligible for Extra Help, she may also qualify for help with her other Medicare expenses through her state's Medicare Savings Program.
State Medicaid programs partner with the federal government, therefore income and asset qualifications vary depending on where she lives. Medicare Savings Programs may pay her entire Medicare Part B premium each month. Some also pay for Part B coinsurance and copayments, depending on her income. Contact your mom's state Medicaid office to determine if she qualifies for benefits in her state.
She can also get help through her State Health Insurance Assistance Program (SHIP), which provides free one-on-one Medicare counseling in person or over the phone. To locate a SHIP counselor in your area, visit the SHIP National Technical Assistance Center website or call the eldercare locator at 800-677-1116.
Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of "The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070.
Published May 25, 2018
