Are You Eligible for Extra Help?

An important benefit to help with Medicare drug costs is still underutilized

The Extra Help program for Medicare Part D prescription drug benefit can be a life saver for some people. This benefit is available to those with limited incomes and resources, and it helps pay the majority of a person’s out of pocket drug costs such as premiums, deductibles, copayments, and costs in the coverage gap or donut hole. Unfortunately, many people who are eligible still do not know about the Extra Help benefit, also known as the Low Income Subsidy (LIS). The Centers for Medicare and Medicaid Services, the agency that administers Medicare, estimates that in Alameda County alone, there are over 22,000 Medicare recipients who are eligible but not yet receiving the Extra Help.

People who are on both Medicare and full Medi-Cal automatically receive the Extra Help and do not have to apply. There are many others however, whose incomes are higher than the limits for full Medi-Cal who should submit an application.

Individuals who make less than $1,300 a month and married couples who make less than $1,750 a month may qualify for this benefit. In addition, these individuals should have resources less than $11,990, and these married couples should have resources less than $23,970 to qualify. Resources include items such as bank accounts and stocks and bonds—but does not include a house or car. 

One woman with Medicare was struggling to pay for her prescriptions even with a drug plan and her $1100/month Social Security benefit. A HICAP Counselor talked to her about how to apply. Once she heard that the value of her house, as long as she lived in it, would not be used to determine if she was eligible, she applied and qualified. She was very relieved.

You can apply online at www.socialsecurity.gov, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778), or go to the nearest Social Security office for assistance. HICAP appointments are also available to assist with the application process. All the information included in the application is confidential.

There is another important way to qualify for the Low Income Subsidy. If someone has Medi-Cal with a Share of Cost and they can meet their share of cost in one month, they automatically become eligible for this benefit. This is true even if their incomes are higher than the limits listed above. If someone meets their Share of Cost for any one month between January and June, they qualify for the Low Income Subsidy for the rest of the calendar year. If they meet their SOC for any one month between July and December, they qualify for the LIS for the rest of the calendar year and the following year!

For more information on this benefit or Medicare Part D in general, give HICAP a call to schedule an appointment:  1-800-434-0222.