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 2023 finances?
With changes in annual qualification requirements, you may now qualify for Extra Help.
Extra Help qualification limits change each year - and the 2023 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 the January increases in your 2023 Social Security benefits make you lose your Extra Help status?
You can reapply now for 2023 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 2023 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 2023
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 ($19,683
if you are single or $26,622
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 ($21,870 if you are single or $29,580 for married couples), you may qualify for "partial" Extra Help (resource limits also apply).
Again, even if you did not qualify for Extra Help last year, you may now qualify based on the new FPL Guidelines.
|2023 Full Low-Income Subsidy Income Requirements (135% of FPL)
States & D.C.
Learn more in our article, 2023 Federal Poverty Level Guidelines (FPL): 2023/2024 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 2022 tax return (reporting 2021 income). However, if you have
had significant changes in your income in comparison to your 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 2023 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.