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How long will I get extra help if I qualify?

If you apply and qualify for extra help

If you qualify for extra help, the decision remains in effect for the calendar year as long as you are enrolled in a Medicare drug plan and there are no changes to your income, resources or family size, or you don’t have a change in your marital status.

Changes in marital status include the following:
  • Marriage
  • Divorce
  • Annulment
  • Separation (not temporary)
  • You and your spouse resume living together after separating
  • Death of spouse
Any of these changes could cause the amount of your extra help to increase, decrease, or end.

If you applied with Social Security and qualified for extra help, you should notify Social Security of any changes in your marital status. If the change in your marital status affects your extra help, the change in extra help will be effective the month after you report the change in your marital status. Changes to your income, resources, or family size can be reported from August–December, and any changes that affect your extra help will be effective January 1 of the following year.

If you applied for extra help through your state and your state determined that you qualify, your state may have rules that require you to report changes in your circumstances to your state.

If you automatically qualify for extra help

You won’t automatically qualify for extra help for the coming year if you no longer qualify for Medicaid, get help from your state Medicaid program to pay Medicare Part B premiums (belong to a Medicare Savings Program), or get Supplemental Security Income (SSI) but not Medicaid.

If you won’t automatically qualify the next year, you will get a notice (on grey paper) in the mail by early fall. If the amount of extra help you get is changing so that your copayment amounts change for next year, you will get a notice (on orange paper) in the mail with the new copayment amounts. If you don’t get a notice, you will get the same level of extra help next year that you have this year.

Even if you get the notice on grey paper because you don’t automatically qualify, you may still be able to save on your Medicare prescription drug coverage costs.

You need to apply for extra help to find out.



(Primary Source: Centers for Medicare and Medicaid Services - Your Guide to Medicare Prescription Drug Coverage 2008. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)
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Tips & Disclaimers
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
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  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
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  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.