Medicare Extra Help or Low-Income Subsidy:
Did you know that Medicare has a special program to help you with your prescription drug costs? Most people have to actually apply for the program, but once you are accepted, you get some benefits that include exemption from the donut hole and exemption from late enrollment penalties. And that's not all you'll get. Medicare Extra Help can help pay for your prescription costs.
There are 4 different levels of Medicare Extra Help (MEH), which is also known as Low-Income Subsidy or LIS.
Take a look at the chart below, but we’ve also included some details on the program.
Qualification for Medicare Extra Help, or MEH, includes nationwide income and asset limits which are set annually. Here are the limits for 2019:
If you have Medicare ONLY
|Income Limit||Your Assets are at or Below||You Pay|
|Up to:1||Single: $9,230|
If you have Medicare and Medicaid and/or a Medicare Savings Program
|Enrolled In||Income Limit||You Pay|
|Medicaid and/or a Medicare Savings Program||Above:|
Couples: $1,429 per month in 20191
Couples: $1,429 per month in 20191
1Income includes money you receive from Social Security, wages, dividends, alimony, and rental property. It does not include funds acquired through loans or a reverse mortgage.
2Assets include bank accounts, IRAs and the value of investments, and real estate (except your home). They do not include your home, vehicles, personal possessions, burial plots or up to $1,500 in savings intended for funeral expenses. Asset limit also includes the allowed amount for burial expenses: Single, $1,500; Couple, $3,000.
3$0 on premium if you have a basic or Full Extra Help. PDP with a premium at or below the Extra Help premium limit for your area.
For those of you who do not like charts, here is the breakdown:
If you qualify for Medicare Extra Help Level 1:
You will get a drug plan premium subsidy of 100%, you will have a zero deductible, and your copays will be $3.40 for generic drugs and $8.50 for brand name drugs. Once you meet the Out-of-Pocket threshold, your copays will be reduced to $0.
If you qualify for Medicare Extra Help Level 2:
Everything is the same as level 1, EXCEPT that your copays will be $1.25 for generic drugs and $3.80 for brand name drugs.
If you qualify for Medicare Extra Help Level 3
Everything is the same as level 1, EXCEPT that your copays will be $0 from the start.
You will receive a PDP premium subsidy of 25-75%, your drug plan deductible will be $85, your copay will be 15% of the drug cost and once you hit your Out-of-Pocket Threshold, you will pay $3.40 for generic and $8.50 for brand name drugs.
No Donut Hole! No late penalty!
Remember, for any level of Low-Income Subsidy, you will not have a donut hole to contend with AND if you signed up for drug coverage late; you will not have to pay the late enrollment penalty. You will also have a continuous special enrollment period so you can change plans outside of the annual enrollment period (AEP) if you need to.
Now you may be thinking these are great benefits, especially the part about not having to worry about the donut hole — but how do I qualify Medicare Extra Help (MEH)?
How to get your (MEH):
There are several methods to apply for Medicare Extra Help.
- You can apply online at http://www.socialsecurity.gov/extrahelp
- You can call Social Security at 1-800-772-1213 or TTY 1-800-325-0778 to apply over the phone or to request an application
- You can apply in person at your local Social Security office
If your assets or income are a little too high:
We recommend that you apply for Medicare Extra Help, even if your assets or income are a little higher than what is shown, because there are some exemptions that may make you eligible. If you qualify, the extra benefits that you receive will most likely far outweigh any time that you spent applying for the program.