Extra Help for Medicare Part D: How Low-Income Seniors Can Save on Drug Costs
The Extra Help program (Low-Income Subsidy) can save qualifying Medicare beneficiaries thousands of dollars per year on prescription drug costs. Here is who qualifies and how to apply.
Extra Help for Medicare Part D: How Low-Income Seniors Can Save on Drug Costs
Prescription drug costs are one of the biggest financial burdens for Medicare beneficiaries -- but many low-income seniors don't know about a program that can dramatically reduce those costs. The Extra Help program (also called the Low-Income Subsidy or LIS) can save qualifying beneficiaries $4,000 or more per year on Part D costs.
What Is Extra Help?
Extra Help is a federal program that helps people with limited income and resources pay for Medicare Part D prescription drug costs -- including premiums, deductibles, and copays.
With full Extra Help, your drug costs are dramatically reduced:
- No Part D premium (or very low premium)
- No Part D deductible
- Very low copays: $3.40 for generic drugs, $8.50 for brand-name drugs (2018 amounts)
- No coverage gap (donut hole)
Who Qualifies for Extra Help?
Income limits (2018):
- Individual: Up to $18,210/year (150% of federal poverty level)
- Married couple: Up to $24,690/year
Asset limits (2018):
- Individual: Up to $13,820 in countable assets
- Married couple: Up to $27,600 in countable assets
What counts as assets: Bank accounts, stocks, bonds, mutual funds, IRAs (in some cases).
What does NOT count: Your home, one car, personal belongings, life insurance with face value under $1,500, burial funds up to $1,500.
Automatic Qualification
You automatically qualify for Extra Help (and are automatically enrolled) if you have:
- Full Medicaid coverage
- Supplemental Security Income (SSI)
- Membership in a Medicare Savings Program (MSP)
If you're automatically enrolled, Social Security will notify you and assign you to a benchmark Part D plan. You can switch to a different plan if you prefer.
How to Apply
If you don't automatically qualify, you can apply:
Online: ssa.gov/extrahelp
By phone: Call Social Security at 1-800-772-1213
In person: Visit your local Social Security office
Through your State Medicaid office: Florida's Department of Children and Families (DCF) can also process applications.
The application takes about 30 minutes. You'll need information about your income, assets, and resources.
Medicare Savings Programs (MSPs)
Medicare Savings Programs are state Medicaid programs that help pay Medicare costs for low-income beneficiaries. Florida has four MSPs:
Qualified Medicare Beneficiary (QMB): Pays Part A and Part B premiums, deductibles, and coinsurance. Income limit: 100% of FPL.
Specified Low-Income Medicare Beneficiary (SLMB): Pays Part B premium only. Income limit: 100-120% of FPL.
Qualifying Individual (QI): Pays Part B premium only. Income limit: 120-135% of FPL.
Qualified Disabled and Working Individuals (QDWI): Pays Part A premium for certain disabled workers.
Enrolling in a Medicare Savings Program automatically qualifies you for Extra Help.
The SHIP/SHINE Connection
Florida's SHINE program (Serving Health Insurance Needs of Elders) provides free counseling to help seniors apply for Extra Help and Medicare Savings Programs. Call 1-800-963-5337 to connect with a SHINE counselor.
Many seniors who qualify for these programs don't apply because they don't know about them. If your income is below $20,000 (individual) or $27,000 (couple), it's worth checking your eligibility.
What Happens If Your Income Changes?
Extra Help eligibility is reviewed annually. If your income or assets change significantly, your eligibility may change. Report changes to Social Security promptly.
We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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About the Author
William Gray
Independent Medicare BrokerUS Air Force Veteran · Florida Medicare Specialist
William Gray is an independent Medicare insurance broker based in Daytona Beach and Palm Coast, FL. A US Air Force veteran (A-10 crew chief, Germany), he spent years in corporate insurance before going independent to serve Florida seniors directly. He has helped more than 1,000 clients across Northeast Florida compare Medicare Advantage, Medigap, and Part D plans — always at no cost to the client.
