What is Medicare Extra Help?

February 7th, 2013 | Posted by Matt Serafini in Medicare Costs | Medicare Part D
3 votes, average: 5.00 out of 53 votes, average: 5.00 out of 53 votes, average: 5.00 out of 53 votes, average: 5.00 out of 53 votes, average: 5.00 out of 5

What is Medicare Extra Help?The Extra Help program covers Part D out-of-pocket costs for eligible beneficiaries.

Medicare details have the potential for confusion, so it is natural to have questions about the program’s intricacies. In the instance of Medicare Part D, some beneficiaries may qualify for federal assistance with the costs of their prescription drug coverage (although drugs and biological products that are paid for by Medicare Part A or B are excluded). This is referred to as the Extra Help program, or low-income subsidy (LIS).

For those who are eligible, the Extra Help program offers financial assistance with monthly premiums, co-pays and co-insurance. Additionally, Extra Help has no coverage gap, meaning that beneficiaries do not have to worry about paying for a significant portion of their prescription prices in the donut hole before the plan’s catastrophic coverage phase kicks in.

Extra Help is available for qualified beneficiaries enrolled in Medicare Part D whose yearly income and resources are limited. According to the Social Security Administration, you could qualify if your combined savings, investments, and real estate are not worth more than $26,580, if you are married and living with your spouse, or $13,300 if you are not currently married or not living with your spouse. Do not include your home, car, household items, burial plot, up to $1,500 in burial expenses (per person) or life insurance policies when calculating your Extra Help eligibility.

Those looking to apply for Extra Help must be approved through both the Social Security Administration and their state of residence. The application process can be started in one of the following two ways:

  • By contacting the Social Security Administration by mail, by telephone, on the Internet at www.ssa.gov, or in person.
  • By contacting their State Medicaid agency.

Additionally, a person may be automatically qualified to receive Extra Help if they have Medicare and meet one of the following conditions:

  • Have full Medicaid coverage.
  • Receive Supplemental Security Income (SSI) benefits.
  • Are Medicare beneficiaries who are existing participants in the Medicare Saving Programs (MSP).

In these instances, those already eligible do not need to apply for Extra Help. The Centers for Medicare & Medicaid Services (CMS) will grant the subsidy based on information received from the person’s state and the SSA. It is still up to the individual, however, to choose a prescription drug plan. Those who do not choose a plan will be automatically enrolled in one by CMS during the month they attain enrollment.

Certain online tools such as the Medicare plan comparison tool provided by PlanPrescriber allow you to find Part D prescription drug plans in your area and compare them side-by-side to find the right plan for your financial and prescription drug needs.

Has Medicare Extra Help been of assistance to you? If not, what do you think about it being available for those with limited finances?

Medicare has not reviewed or approved this information.

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2 Responses

  • daniel mclean says:

    I have extra help does this help pay for a c pap it is going to be 125.00 for the first month can the extra help program help pay for this

    daniel mclean did not rate this post.
    • Hi Daniel,

      Thank you for your question. The Extra Help program helps you pay for the costs related to your Medicare prescription drug coverage, including premiums, deductibles, and copayments. Because CPAP therapy is not considered a prescription drug, it would not be covered under the Extra Help program. If you wish to learn more about how other aspects of Medicare may cover CPAP therapy, please consult the Medicare.gov page on the topic: http://www.medicare.gov/coverage/sleep-apnea-and-cpap-therapy.html.

      Quinn Korzeniecki ratings for this post: Quinn Korzeniecki gives a rating of 5Quinn Korzeniecki gives a rating of 5Quinn Korzeniecki gives a rating of 5Quinn Korzeniecki gives a rating of 5Quinn Korzeniecki gives a rating of 5


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