You help you clients find the best Medicare plans for their needs, but some of them might need a little extra help.
Prescription drugs can be expensive – so expensive that some of your clients might not be able to afford them. That can lead to difficult decisions, like having to choose between skipping potentially life-saving medicine or going without other necessities.
Help is available. For Medicare enrollees who meet the income and resource limits, the Extra Help program provides low-income subsidies to help with prescription drug costs. Make sure your clients know about this program and how to apply.
Applying for Extra Help
Eligibility for Extra Help is based on income and resources. In 2021, the income limit is $19,320 per year for an individual and $26,130 for a married couple. The resource limit is $14,790 for an individual and $29,520 for a married couple. When calculating resources, the beneficiary’s home, one car, burial plot, furniture, household items and personal items should NOT be included. The beneficiary can also exclude up to $1,500 for burial expenses.
Some people qualify for Extra Help automatically because they receive Medicaid coverage or Supplemental Security Income benefits. People who do not automatically qualify can enroll through the Social Security Administration website. If they need help with the application, they can call 1-800-772-1213 (TTY 1-800-325-0778).
Receiving Extra Help
Applying for Extra Help does not enroll Medicare beneficiaries in a prescription drug plan. Make sure your clients also select and enroll in a suitable Medicare plan that includes coverage for any prescriptions they take.
In 2021, Medicare beneficiaries who are receiving Extra Help should pay no more than $3.70 for each generic drug and $9.20 for each brand-name covered drug. Beneficiaries will also pay less, or possibly even nothing, for their prescription drug plan premium and deductible.
What About Clients Who Need More Help?
The Extra Help program provides low-income subsidies to help with the costs of prescription drugs, but it does not help with other Medicare costs. If your clients need additional help, they should see if they qualify for the Medicare Savings Programs. To apply for these programs, they will need to contact the Medicaid department in their state.
Many seniors struggle with healthcare costs, and they might not realize that help is available. Reach out to them to make sure they know where to find assistance.
- Tell them about the Extra Help program, as well as the Medicare Savings Programs.
- Encourage them to apply – even if they aren’t sure they qualify.
- Give them links to the Social Security Administration website for Extra Help.
- For help with Medicaid, direct your clients to the Medicaid department in their state. In Texas, they can contact the Texas Health and Human Services Department.