If I am Dual Eligible and qualify for Extra Help, will my Medicare Part D drug plan premium always be $0?
Not always. If you are "Dual Eligible", qualifying for
both Medicare and Medicaid, you will automatically qualify for the Medicare Part
D Low-Income Subsidy (LIS) or Extra Help program.
If you have LIS benefits
and you enroll in a
stand-alone Medicare Part D plan that qualifies as one of your state's $0
premium LIS plans, you will pay a $0 monthly premium.
However, if you qualify for LIS benefits and enroll in a Medicare Part D
plan that
does not qualify for your state's $0 LIS premium,
you will pay a small monthly premium that is roughly calculated
as the difference between your state's benchmark premium and the Medicare plan's
premium.
The good news is that, if you qualify for Medicare Part D Extra Help, you are
granted a
Special
Enrollment Period (SEP) that allows you to change your Medicare Part D or
Medicare Advantage plan enrollment once per quarter, during the first nine
months of the plan year. Your newly chosen plan becoming effective the first day
of the month after enrollment.
Question: Which Medicare Part D plans qualify for the $0 premium?
You can
quickly see the Medicare Part D plans
(PDPs) in your state that qualify for the $0 premium (that is, the PDPs that
meet your state's $0 LIS benchmark premium and offering a basic or standard
Medicare Part D plan design (
DS,
AE,
BA)) at
PDP-Finder.com/FL.
Please note: you will notice that a low-costing Medicare Part D
plan in the 2023 example graphic below (
see current plans here) does not qualify for the $0 premium -- even though its
premium is less than the
Florida $0 benchmark premium ($35.92) -- because the plan offers
enhanced (
EA)
Medicare Part D coverage rather than basic coverage. You will
also notice that a Medicare Part D plan may meet the state $0 benchmark premium
in one state and not qualify for the $0 premium in another state.
But, state
LIS benchmark premiums
and Medicare Part D
plans change each year - and the Medicare plans that qualify for the state's $0
benchmark premium also change each year. You can see how Medicare Part D
plans change each year using our Medicare Part D compare tool (
PDP-Compare.com/CA).
So as you can see in the 2022/2023 example below using
PDP-Compare, it is possible that your
Medicare Part D plan might qualify as a $0 premium plan one year and then
next year the same Medicare plan does
not qualify for the $0
premium.
A bit of history...
Plan year 2023 was the last year for partial-LIS benefits. Starting with 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.
Question: Where can I see the 2023 plan premium if I had partial-LIS benefits?
In the past, you may have only qualified for
partial-LIS benefits (instead of full-LIS benefits);
however, beginning in plan year 2024, full-LIS benefits have been expanded to
150% of FPL
and therefore full-LIS benefits are extended to beneficiaries who formerly received only partial-LIS benefits. See more about Medicare Part D changes made through the
Inflation Reduction Act (IRA).
For plan years prior to 2024, you can click on the Medicare Part D plan name while using
PDP-Finder or
PDP-Compare, and scroll through the plan's
coverage details to see the premium you would pay with full-LIS status or
partial-LIS status (see 2023 example below).
More 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?"
To learn more and apply for Extra Help, you can call Social Security at
1-800-772-1213 (TTY 1-800-325-0778) or visiting
www.socialsecurity.gov
or contact your local state Medicaid office.
For more assistance with choosing a Medicare Part D or Medicare Advantage plan
call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Or you can visit the Medicare.gov
Medicare Prescription Drug Plan Finder for a
list of the Medicare drug plans available in your area.
Again, to help with your plan search, we also offer our
Medicare
Part D Plan Finder and
Plan Overview by State.
(Primary source: U.S. Department of Health & Human Services)