extra help paying for scripts

I’m often asked if Medicare offers any financial assistance programs to help people with their medication costs.

As it happens, yes, there is a low-income subsidy program called ‘Extra Help’ that assists Medicare beneficiaries on a tight budget by paying for their monthly premiums, annual deductibles, and co-payments related to their Medicare (Part D) prescription drug coverage.

And thanks to the Inflation Reduction Act that was passed by Congress and signed into law in late 2022, this program has expanded and gotten easier to qualify for in 2024. Even if you’ve applied and didn’t qualify previously, you may be eligible now.

The Extra Help benefit is estimated to be worth about $5,300 per year. Currently, over 13 million people nationwide are receiving this subsidy, but there are around three million more who may qualify but don’t know it.

The amount of financial assistance you would receive depends on your income and assets. If you qualify, you’ll pay no premium or deductible (unless receiving a partial subsidy), and no more than $4.50 for each generic drug or $11.20 for each brand-name drug your plan covers in 2024.

To get the subsidy, your resources (assets) must be equal to or below $17,220 as an individual or $34,360 for married couples living together. Bank accounts, stocks, bonds, mutual funds and IRAs count as assets, but your home, vehicle, personal belongings, life insurance and burial plots do not.

Also, annual income cannot exceed $22,590 for an individual or $30,660 for married couples. If you support a family member who lives with you, your income can be higher. In addition, the government won’t count any money if you receive help for household expenses like food, rent, mortgage payments, utilities and property taxes.

How to Apply
There are three ways to see if you qualify and apply for Extra Help: (1) online at SSA.gov/medicare/part-d-extra-help; (2) by calling Social Security at 800-772-1213; or (3) by visiting your local Social Security office.
The application form is easy to complete, but you will need your Social Security number and information about your bank balances, pensions and investments. Social Security will review your application and send you a letter within a few weeks letting you know whether you qualify.

If you don’t meet the guidelines for Extra Help, you may still be able to get help from a state pharmacy assistance program or a patient assistance program. Visit NeedyMeds.org to search for these programs.

Other Medicare Assistance
You may also qualify for New York State’s Medicare Savings Program (MSP), a Medicaid-administered program that can help pay Medicare premiums. When you enroll in an MSP, you automatically get Extra Help. There is no resource test for the MSP programs. Go to https://www.health.ny.gov/health_care/medicaid/program/update/savingsprogram/ for more information and to apply.

New York State also offers EPIC: the Elderly Pharmaceutical Insurance Coverage program as a secondary payer to Medicare Part D prescription drug coverage. Call 914-813-6300 to learn more about how you may qualify.

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