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Senior couple speaking with an advisor

How “Extra Help” Can Lower Your Drug Cost

Filling prescriptions may be your most significant medical expense if you take many drugs or even a few costly ones. The Part D prescription drug program helps up to a point, but the premiums of its deductibles and copays, not to mention the higher costs of the doughnut hole if you fall into it, add up to outlays of cash many folks cannot afford. Main points about the “Extra Help” Program

Suppose you were receiving Medicaid before joining Medicare. If so, you will now get the drug coverage of yours from Part Ds extra Help program and not from Medicaid, even if you carry on and qualify for Medicaid.

In case you have full Medicaid coverage or perhaps supplemental security income if your state pays your Medicare premiums or maybe qualifies for a Medicaid medical spend-down program, you are eligible automatically for full extra Help.

If you do not qualify for full Extra help, you might be eligible for extra partial Help, which also provides coverage at lower costs than in the standard Medicare Part D program.

Additional Help is a lot more comfortable to apply for than many assistance programs, but you have to offer details of your income and resources or assets.

Everyone, whether qualifying for partial or full assistance, gets full drug coverage throughout the season. Nobody receiving Extra Help must deal with the dreaded doughnut hole.

Anybody with Extra Help can switch to a different Part D drug plan at any time of the year, no waiting until enrollment rolls around.

Getting Extra Help does not affect your eligibility for SSI or perhaps assistance that pays the costs of heating or possibly cooling your house.

Bear in mind that qualifying for Extra Help even automatically is just one step in the process. You will still have to sign up for a Part D drug plan to get your prescriptions covered.

Qualifying for Extra Help.

  • Level 1: you have full Medicaid benefits and live in an institution such as a nursing home.
  • Level 2: You have full Medicaid benefits and income no higher compared to $1025 per month 
  • Level 3: you have full Medicaid benefits, and your revenue is above the amounts in the preceding bullet, or perhaps you receive SSI, or maybe your state pays your Medicare premiums.
  • Level 4: Your income is no higher than $1377 per month, and your savings are under $8890
  • Level 5: your income is no higher than $1528 per month, and your savings are even under $13820.

Applying for Extra Help

  • Online
  • By Phone
  • In-person
  • By mail

What counts as income

  • Pretax wages or perhaps earnings from self-employment
  • Social security or possibly railroad benefits before deductions
  • Veterans benefits
  • Annuities and pensions
  • Workers compensation
  • Alimony
  • Net income from rental property

What counts as assets?

  • Bank accounts including checking certificates and savings of deposit
  • Proceeds of a loan inf saved beyond the month they are received
  • Cash kept at home or perhaps anywhere else
  • Individual retirement accounts and 401ks
  • Stocks and bonds mutual funds
  • Real estate

Who can help me apply?

How can I complete the application process?

  • Using the printed application form
  • Applying to social security online
  • Laying on the benefits check-up site

What happens after I apply?

Social security sends you a notice saying has received the application of yours and is processing it

  • You might hear from Social Security by mail or phone in case it is extra questions
  • You might obtain a pre-decisional notice saying your application will probably be turned down

Social Security decides whether you are eligible for Extra Help

What if social security turned me down?

 

  • Request a telephone hearing
  • Ask for a case review
If I qualify, how long does the Extra Help last?

You can lose extra Help next year if:

      • Your income goes above the limits for Extra Help
      • The importance of the savings of yours along with other countable assets rises above the asset limit for extra Help
      • You will not qualify for one of the programs that makes you automatically eligible for Extra Help
How can I know whether the additional Help will continue?
  • In case you are suitable for Extra Help automatically
  • In case you are ideal for Extra Help through a Medicaid medical, spend down
  • In case you are ideal for Extra Help by applying

Choosing a drug plan with additional Help Applying and qualifying for additional Help is only one step in the process. You will still have to be in the Medicare part D drug plan to get coverage for your medications. You have the right to sign up for the Medicare drug plan of your choosing.

Understanding the automatic enrolment system
  • In case you qualify for Extra Help automatically and do not immediately sign up with a program on your own, Medicare enrolls you in one to ensure you continue to get the medications, particularly if you are being moved from Medicaid to Medicare for your drug coverage
Clarifying zero premiums With Extra Help

No premium for the content. The tip is waived only if you join a drug plan that charges regular premiums below a particular dollar amount.

How can you know which plans in your area give you a zero premium and not in any given year? These plans and the phone numbers are included in the blue notice Medicare sends you. But to make sure of what you would pay for each of the drugs, you’ve three options:

  • Make use of the Medicare online plan finder program.
  • Call Medicare helpline. 
  • Call your state Health insurance assistance program.
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