What is the Medicare Extra Help Program?

Extra Help is a program that helps cover more Part D drug costs for certain people with limited resources and income.

Helpful Highlights

  • If your loved one has limited income and resources (amounts stated below), they may qualify for Extra Help, a program to help pay for some drug costs.

  • Starting January 1, 2024, Extra Help will expand to cover more drug costs for certain people with limited income and resources.

  • Your loved one may qualify even if they have a higher income (if they still work, live in Alaska or Hawaii, or have dependents living with them).

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If your loved one has limited income and resources that are below the following limits in 2023, they may qualify for Extra Help.

Income

Single: Yearly income less than $21,870

Married (living with spouse and no other dependents): Yearly income less than $29,850

Resources

Single: Resources less than $16,600

Married (living with spouse and no other dependents): Resources less than $33,240

Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs).

Resources do not include home, car, household items, burial plot, up to $1,500 for burial expenses (per person), or life insurance policies.

If your loved one qualifies for Extra Help and joins a separate Part D (prescription drug) plan or Part C (Medicare Advantage) plan with drug coverage, they will get help to pay for their drug coverage costs and will not pay a Part D late enrollment penalty.

Automatic qualification

Your loved one automatically qualifies for Extra Help if they have Medicare and meet any of these conditions:

  • Have full Medicaid coverage

  • Get help from state Medicaid program to pay their Part B premiums and other Medicare costs

  • Get Supplemental Security Income (SSI) benefits

In this case, Medicare will mail your loved one a purple letter to let them know they automatically qualify for Extra Help. They do not need to apply for Extra Help if they get this letter. Keep this letter for your records.

To use Extra Help, your loved one must get Part D if they don't already have it. Medicare may enroll your loved one in a separate drug plan so they will be able to use the Extra Help. If Medicare enrolls them in a plan, they will get a yellow or green letter letting them know when their coverage begins and they'll have a Special Enrollment Period to change plans if they want to join a plan different than the one Medicare enrolled them in.

Applying for Extra Help

If your loved one doesn't automatically qualify for Extra Help, they can apply at any time:

When your loved one applies for Extra Help, they can also begin the application process for a Medicare Savings Program (MSP). These state programs provide help with other Medicare costs. Social Security will send information to their state to initiate an MSP application unless your loved one tells them not to on the Extra Help application.

Note that most people with Medicare can only switch plans at certain times of the year. However, if your loved one has Medicaid or Extra Help, they may be able to change their drug coverage one time during each of these periods:

  • January - March

  • April - June

  • July - September

If they make a change, it will begin the first day of the month following when the change was made.

Only available in the 50 States

Extra Help is not available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. There are other programs available in these areas to help people with limited income and resources. Call your loved one's State Medical (Medicaid) Assistance office to learn more. Visit State Medicaid Links for state Medicaid office information and contact details.

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