Do you qualify for Medicare Extra Help?

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The Medicare Extra Help program for Part D is designed to help with the costs of prescription drug coverage. Medicare Extra Help was created to assist with premiums, co-pays, and deductibles. The following is a guide to help you determine if you are eligible for the Extra Help program.

Automatic Qualification for Medicare Extra Help

You will receive automatic qualification for the Extra Help program if:

  • You are eligible to receive both Medicare and Medicaid
  • You have a Medicare Savings Program
  • You receive Supplemental Security Income (SSI)

Income and Resource Eligibility Requirements

If you do not automatically qualify, there are two broad categories used to determine eligibility for the Extra Help Program: income requirements and resource requirements.

Income Requirements

Generally, a single person must have an annual income of less than $18,735 and a married couple less than $25,365 to qualify for Medicare Extra Help. The income limits are 150% of the federal poverty level.

Even if your income is above this, you may still be eligible for the program. If you are providing for other family members in your household, then the qualifying income requirements increase. For example, 150% of the federal poverty level for a 3 person household is $31,995, and $38,625 for a 4 person household. Household members can include children, grandchildren, parents, and others.

The federal poverty level is more in Alaska and Hawaii. For Alaska, 150% of the federal poverty level is $23,400 for an individual, $31,695 for a couple while it is $21,570 and $29,190, respectively, in Hawaii.

Certain types of income will be excluded when determining whether you qualify for Extra Help. Some of the most common examples include:

  • SNAP (food stamps) benefits
  • Housing assistance
  • Scholarships and education grants
  • Awards and payments for personal injury
  • Disaster assistance
  • Assistance for medical treatment and drugs

If you have more sources of income, you may find that those are exempt as well. To be sure, you should contact your local Social Security office to determine if those income sources will be calculated when determining your eligibility.

Resource Limits

Eligibility is also determined based on your resources. Resources are the things that you own. The more common resources include: 

  • Bank accounts, including checking, savings, and money market accounts
  • Stocks, bonds, ownership interests
  • Individual Retirement Accounts
  • Cash
  • Real Estate holdings that are not your primary residence

There are also a set of items that you may own that will not count as resources for Extra Help eligibility, these include:

  • Primary residence
  • Personal property like furniture, clothes, appliances, etc.
  • Personal automobile
  • Money earmarked for burial expenses
  • Life Insurance

As with the income requirements, if you have a question as to whether a particular resource will count towards eligibility, it is essential to contact your local Social Security office.

The resource limits are currently $14,390 for an individual and $28,720 for a married couple living together.

Benefits Based on Income

Benefits are based on the income you report on tax returns. If your income is 135% or less of the federal poverty level, then you will receive a full, 100% premium subsidy. For income levels, more than 135% of the federal poverty level but not more than 140%, a 75% subsidy will apply. Income above 140% of the federal poverty level but less than 145% will receive a 50% subsidy, while anything less than 150% but more than 145%, will receive a 25% subsidy.

How to Apply for Medicare Extra Help

Applying for the Extra Help program is easy – fill out the Application form Form SSA-1020 and submit it to social security.  Additionally, you can call 1-800-325-0778 or visit your local Social Security office to apply.

If you don’t qualify for Medicare Extra Help but are having trouble paying for your prescriptions, we can assist you in finding other options.

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Justin Brock

President & CEO of Bobby Brock Insurance