The Low Income Subsidy/Extra Help Program for Medicare Part D

The Low Income Subsidy (Extra Help) is a program run by the Social Security Administration (SSA). It provides help to pay for your Medicare Part D premiums (monthly cost), deductibles, and co-payments.

To qualify for Extra Help you must:

• Live in one of the 50 states or the District of Columbia.
• Have Medicare Part A and Part B
• Have limited financial resources. This includes your income and your resources.
  • Income must be less than $1903 a month for singles; $2575 a month for couples.
  • Resources which includes stocks, bonds, and money in a checking, savings, or retirement accounts must be below $17,220 ($34,360 for a couple)
    • Resources do not include your home, car, burial plots, or life insurance.
    • There may be some exceptions to these income limits if you:
      • Support other family members who are living with you.
      • Additional income you may have from the work you do.
      • Live in Alaska or Hawaii, as the standard cost of living is higher in these states.

How do I apply?

• Apply online www.socialsecurity.gov/extrahelp
• Call SSA at 800-772-1213
• Apply at your local SSA office

What happens once I’m approved?

• You still need to pick a Medicare part D plan. If you don’t, the Centers for Medicare and Medicaid Services will pick it for you. You can search for plans in your area at www.medicare.gov or call 1-800-MEDICARE for help.
• Once you are approved for the program, there are no premiums and deductibles for your drug coverage. You will pay co-pays for each prescription but the maximum copay is $11.20 for brand name drugs and $4.50 for generics. 
• You may also want to apply for Medicare Savings Programs. These programs can help you with your Medicare Part B premiums. For some people, the Medicare Savings Program also covers Part A premiums and Part A and B deductibles and copayments. Each state has its own rules for these programs. SSA will send information to your state’s Medicaid office to help you apply for a Medicare Savings Program.

If you meet the requirements for Low Income Subsidy/Extra Help, apply today! It can save you a lot of money on prescription costs. If you need help applying, ask your healthcare provider, social worker, or navigator.

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