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Reminder: You may now qualify for Medicare Part D financial Extra Help

Category: Medicaid, LIS, & Extra Help
Published on 2022-03-01 13:10:25
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If you are eligible for Medicare and having difficulties paying for your prescription drugs, you may want to learn more about the Medicare Part D Extra-Help program by calling or visiting a local state Medicaid office or calling the Social Security Administration at 1-800-772-1213.

Extra Help or the Low Income Subsidy (LIS) is a government program that helps Medicare beneficiaries pay all or part of their monthly Medicare Part D drug plan premiums, deductibles, and may cover a significant portion of their prescription drug costs.

If you already qualify for Medicaid, you will automatically qualify for the Medicare Part D Extra Help and do not need to apply.

However, even if you do not meet the financial qualifications for your state Medicaid program, you may still qualify for at least partial Extra Help benefits based on your annual income and financial resources (or assets) - and still save money on your prescription drugs. 

No change in 2022 finances?
With changes in annual qualification requirements, you may now qualify for Extra Help.

Extra Help qualification limits change each year - and the 2022 income and resource limits for the Medicare Part D “Extra Help” program have recently been increased, so you may now be eligible for the “Extra Help” program --- even if you have not experienced changes in your financial situation.

Did January increases in your 2022 Social Security benefits make you lose your Extra Help status?
You can reapply now for 2022 Extra Help.

Some people may have lost their Part D Extra Help benefits this past January when their monthly Social Security benefits increased pushing them above the Extra Help income limits, but these people are urged to re-apply for 2022 Extra Help now based on the newly released Extra Help qualification limits.

Partial or Full Extra Help based on Income and Assets

The income limits for Extra Help are based on the government's 2022 Federal Poverty Level (FPL) Guidelines that are adjusted each year and include the following information:
  • If your annual income is at or below 135% of FPL ($18,347 if you are single or $24,719 for married couples), you could qualify for the "full" Low-Income Subsidy (resource or asset limits also apply).

  • If your annual income is at or below 150% of FPL ($20,385 if you are single or $27,465 for married couples), you may qualify for "partial" Extra Help (resource limits also apply).
Important:  Again, even if you did not qualify for Extra Help last year, you may now qualify based on the new FPL Guidelines.

2022 Full Low-Income Subsidy Income Requirements
(135% of FPL)

Persons
in Family

48 Contiguous
States & D.C.


Alaska


Hawaii

1

$18,347

$22,937

$21,101

2

$24,719

$30,902

$28,431

3

$31,091

$38,867

$35,762

4

$37,463

$46,832

$43,092

5

$43,835

$54,797

$50,423

6

$50,207

$62,762

$57,753

To learn more, please see our article: 2022 Federal Poverty Level Guidelines (FPL): 2022 LIS Qualifications and Benefits.

Your tax return and changing financial status

Typically, the Extra Help application uses the most recent tax return information sent to Social Security from the IRS.  This would currently be your 2021 tax return (reporting 2020 income).  However, if you have had significant changes in your income in comparison to your 2021 tax return, you can appeal to Social Security to use more recent income figures.  Please see: How to appeal the decision Social Security made on your application for Extra Help.

Qualifying for Medicaid and Medicaid Spend-down

As a reminder, Medicaid “Spend down” allows you to subtract your medical expenses (for example, what you pay for your prescription medications) from your annual income so that you might become eligible for your state’s Medicaid program based on the cost of healthcare.  In other words, you may be eligible for your state’s Medicaid program based on the principle of “Spend-Down”, even if you would otherwise earn too much to qualify for Medicaid.  You can click here to read more about Medicaid Spend Down.

Extra Help status and changing 2022 Medicare Part D or Medicare Advantage plans.

If you qualify for Extra Help, you are granted a Special Enrollment Period (SEP) allowing you to change your Medicare plan once per quarter during the first nine (9) months of the plan year.  You can telephone a Medicare representative at 1-800-Medicare (1-800-633-4227) for assistance finding the most economical health and prescription drug coverage.

To review co-payments for both Full- and Partial-LIS, select the year-related link below:

 2023 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2022 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2021 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2020 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2019 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2018 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2017 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2016 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2015 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2014 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL
2013 LIS Copayment Benefits:  100% FPL    135% FPL     150% FPL

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  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
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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 Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
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