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Help with drug costs

For many Medicare beneficiaries, prescription drug costs can be a significant financial burden. Fortunately, Medicare offers a program called "Extra Help" to assist those with limited income and resources. This blog post will explore the Extra Help program and other strategies to manage your Medicare drug costs effectively.

What is Extra Help?

Extra Help is a Medicare program designed to reduce the costs associated with Medicare prescription drug coverage (Part D). This assistance can significantly lower your expenses for:

  • Premiums

  • Deductibles

  • Coinsurance

  • Copayments

One of the most significant benefits of Extra Help is that it eliminates the Part D late enrolment penalty for those who qualify.

Who Qualifies for Extra Help?

Automatic Qualification

Some individuals automatically receive Extra Help if they:

  • Have full Medicaid coverage

  • Receive help from their state to pay Medicare Part B premiums (through a Medicare Savings Program)

  • Receive Supplemental Security Income (SSI) benefits

Income and Resource Limits

For those who don’t automatically qualify, eligibility is based on income and resource limits. As of 2024, the limits are:

Situation Income Limit Resource Limit

Individual

$22,590

$17,220

Married couple

$30,660

$34,360
Note
 These limits may be higher for residents of Alaska and Hawaii.

How to Apply for Extra Help

If you don’t automatically qualify, you can apply for Extra Help through:

  • The Social Security Administration website

  • Your local State Health Insurance Assistance Program (SHIP)

Tip
 You can apply for Extra Help and Medicare Savings Programs simultaneously, potentially increasing your overall assistance.

Benefits of Extra Help

Those who qualify for Extra Help in 2024 can expect:

  • $0 plan premium

  • $0 plan deductible

  • Reduced prescription costs:

    • Up to $4.50 for each generic drug

    • Up to $11.20 for each brand-name drug

Once your total drug costs reach $8,000, you’ll pay $0 for each covered drug.

Important
 If you have full Medicaid coverage and are in the Qualified Medicare Beneficiary (QMB) program, your maximum copayment for covered drugs is $4.60.

What If You’re Paying the Wrong Amount?

If you believe you’re being charged incorrectly:

  1. Contact your drug plan and provide proof of your Extra Help status.

  2. Call 1-800-MEDICARE (1-800-633-4227) for assistance.

Remember, you may be eligible for reimbursement if you paid for prescriptions after qualifying for Extra Help but before enrolling in a Medicare drug plan.

Other Ways to Lower Your Prescription Drug Costs

Even if you don’t qualify for Extra Help, there are several strategies to reduce your medication expenses:

  1. Compare Medicare drug plans to find the most cost-effective option for your needs.

  2. Investigate pharmaceutical assistance programs offered by drug manufacturers.

  3. Check if your state provides additional help with drug costs.

  4. Discuss generic alternatives or cheaper brand-name options with your doctor.

  5. Consider using mail-order pharmacies, which can sometimes offer lower prices.

Staying Informed About Your Extra Help Status

If you qualify for Extra Help:

  • You’ll be automatically enrolled in a Medicare drug plan if you don’t already have one.

  • You’ll receive a letter detailing your new plan and cost information.

  • Your Extra Help status is typically reviewed annually. You’ll only receive a letter if your status changes or you no longer qualify.

Conclusion

Managing Medicare drug costs can be challenging, but programs like Extra Help and various cost-saving strategies can make a significant difference. Stay informed about your options, regularly review your coverage, and don’t hesitate to seek assistance when needed. Remember, your financial situation may change, so you can reapply for Extra Help at any time if you don’t initially qualify.

Tip

For the most up-to-date information on Medicare drug costs and Extra Help:

  • Visit https://www.medicare.gov

  • Call 1-800-MEDICARE (1-800-633-4227)

  • Contact your local State Health Insurance Assistance Program (SHIP)

By understanding your options and taking advantage of available resources, you can better manage your Medicare drug costs and ensure access to the medications you need.

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