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What is Extra Help?


The Medicare Part D Extra Help or Low-Income Subsidy (LIS) program helps people with limited financial resources pay for their Medicare Part D prescription drug coverage.

If you receive Medicare Part D Extra Help, you may pay a lower - or $0 monthly premium, a lower or $0 initial deductible, have continuous coverage even through the Donut Hole or Coverage Gap, and pay very little for your prescription drugs that are covered by your Medicare Part D plan.

Extra Help eligibility is based on the income you earn and the financial resources you own - and the financial limits can change every year..

For example, in 2020, you will qualify for Extra Help if your income is below $19,140 per year for a single person (or $25,860 for a married couple living together or even more if you have dependent children or grandchildren living with you), AND if your assets are below $14,610* for a single person (or $29,160* if you are married).

*includes the $1,500 burial allowance.

The following items are NOT included in the income calculation:
  • Housing assistance,
  • Medical treatment and drugs,
  • Food stamp assistance, etc.
The following items are included in resources:
  • bank accounts,
  • stocks and bonds,
  • Real estate (other than your primary residence), etc.
The following items are NOT included in resources:
  • the house you live in,
  • your car,
  • other personal possessions such as your furniture and jewelry, etc

Medicaid and Extra Help

If you qualify for your state's Medicaid program, you automatically qualify for the Medicare Part D "Extra Help" program that may lower the cost of your prescription drugs.

If you are qualified for Medicaid and are automatically qualified for Extra Help, Medicare will mail you a letter about your Extra Help.

If you get one of these letters, keep it for your records.

You still need to join a Medicare Part D drug plan (PDP) or Medicare Advantage plan (MAPD) to get Medicare prescription drug coverage.

You may be automatically enrolled into a Medicare Part D plan

If you do not join a Medicare Part D drug plan, Medicare may enroll you into a plan to make sure you have drug coverage.  If Medicare enrolls you in a plan, Medicare will send you a letter explaining when your coverage begins.

If you want to choose your own Medicare Part D plan or do not want to join a Medicare Part D drug plan (for example, because you want to keep your employer or union coverage instead), you can call 1-800-MEDICARE (1-800-633-4227) or the plan listed in your letter and tell a Medicare representative you do not want to be in the Part D plan - or you would like to choose your own Medicare Part D plan coverage rather then the plan selected automatically.

Remember: you must be in a Medicare Part D drug plan (PDP or MAPD) to take advantage of the Extra Help program this extra help.

You may qualify for "Partial" Extra Help

Even if you do not qualify for 100% Extra Help, you may qualify for partial Extra Help that still lowers the cost of your prescription drug coverage.  You can contact your local state Medicaid office for more information about partial Extra Help benefits.

Read more about Medicaid, LIS, & Extra Help.





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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • 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.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • 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.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • 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.
  • 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.
  • 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.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • 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.