If you qualify for the Medicare Part D Extra Help
program or Low-Income Subsidy (LIS), then you will never enter the Donut
Hole or Coverage Gap and the cost of your prescriptions will remain constant throughout the year - and will only change if you
reach the Catastrophic Coverage portion of your Medicare Part D plan.
And you will only reach the Catastrophic Coverage phase
when your total out-of-pocket drug spending exceeds the annual threshold (for example, $6,550 in 2021
). In Catastrophic Coverage, your drug costs will usually be greatly reduced. (Costs in the Catastrophic Coverage phase can be as low as $0 or just slightly more based on your level of Extra Help
Since a person qualified for Extra Help
never has a Coverage Gap in their Medicare Part D plan, they also will not receive the 75% Donut Hole discount
, but instead will continue to pay low prices for your formulary brand and generic prescription drugs throughout the year.
For more details of Extra Help drug copayments, here are examples of full- and partial-Extra Help drug costs for: 2019
, 2020, and
Important: You can apply for Medicare Part D Extra Help at any time!
Remember, if you have limited income and financial resources, you can apply for the Medicare Part D Extra Help program (or Low-Income Subsidy) and receive help paying for your prescription drugs.
You can apply for Extra Help at any time of the year by visiting your local state Medicaid office, going to the Social Security website (www.socialsecurity.gov), or calling Social Security at 1-800-772-1213 (TTY users 1-800-325-0778).