Archive: I receive Extra Help so why does my 2023 Medicare Part D coverage have an initial deductible?

Plan year 2023 was the last year for partial Extra Help, when you could have a deductible based on your FPL level (see below for explanation). For plan year 2024, the Inflation Reduction Act (IRA) increased full Extra Help benefits to people at or below 150% of FPL and consequently, the current partial Extra Help (135% to 150% of FPL) designation will be eliminated.

If you are eligible for the Medicare Part D Extra Help or Low-Income Subsidy program, you should pay only a small copayment for prescriptions covered by your Medicare plan, and, depending on your level of Extra-Help, you should not pay an initial deductible.

If you find that your Medicare Part D plan coverage includes an initial deductible, there may be several explanations.

First, if you are new to the Extra Help program, it is possible that your assistance status is not yet up-to-date in the Medicare system and your Medicare Part D provider is unaware that you should not have a deductible based on your Extra Help status.

Next, it is also possible that, based on your financial status, you only qualify for partial Extra Help benefits and therefore you do have a deductible, although it is a reduced deductible. For example, in 2023, the standard deductible is $505, and the deductible for people with income between 135% and 150% FPL is $104.
There is also the possibility that you are qualified for full Extra Help benefits, but there was simply an error made showing that you were responsible for an initial deductible instead of having your formulary medications covered immediately.

For more information, you can contact your local Social Security office or your State Assistance agency to be sure that your information is accurately entered in their computer system. Also check to see if you receive full- or partial- Extra Help.

Once you are sure that your information is correct with your assistance agency, then you should contact your Medicare Part D provider directly to ensure that your information in their computer reflects your assistance level. The toll-free telephone number for your Medicare plan's Member Services department is printed on your membership card or Member ID.

For additional information, please see our FAQ:
"I am qualified for Medicaid and Medicare, so why am I still paying a premium for my Medicare Part D prescription drug plan?" found at on this site and learn more in our article, 2023 Federal Poverty Level Guidelines (FPL): 2023/2024 LIS Qualifications and Benefits.