This year, the Social Security Administration mailed out 20 million prescription assistance application form to people who meet the initial criteria. One out of three Medicare recipients are expected to qualify for this extra assistance. People who qualify may also be eligible for Medicare Part B premium, deductible and co-insurance assistance, especially if they have low additional income and a minimal savings. The Extra Help program provides an average of an additional $3,900 to people who need it most.
The Extra Help prescription assistance program is split into 4 levels, each with different benefits and qualifications. Here’s the breakdown and benefits for each level:
Level 1: People who live in nursing homes and receive full Medicaid benefits automatically qualify and receive full benefits.
Level 1 benefits: No cost for prescription drugs.
Level 2: People whose Medicare premiums are paid by the state or who receive benefits from both Medicaid with prescription drug coverage and Medicare or Medicare and Supplemental Security Income get Extra Help automatically and don‘t need to apply.
Level 2 benefits: There is no premium or deductible for Medicare drug coverage and a sliding scale of drug copay that depends on your income. You will be required to pay either $1.10 or $ 2.40 for generics and $3.20 or $6.00 for brand-name drugs. There is no cost for catastrophic coverage.
Level 3: Your yearly income must be less than $14,040 for an individual or $18,900 for a married couple living in the same house. In addition, your financial assets like bank accounts, life insurance, stocks and bonds must not total more than $8,100 for an individual or $12,910 for a married couple. Your home and automobile do not count as resources.
Level 3 benefits: Drug costs will be $2.40 for generics and $6.00 for brand-name drugs. There is no cost for catastrophic coverage.
Level 4: Your yearly income must be less than $15,600 for an individual or $21,000 for a married couple living in the same house. In addition, your financial assets like bank accounts, life insurance, stocks and bonds must not total more than $11,990 for an individual or $23,970 for a married couple. Your home and automobile do not count as resources.
Level 4 benefits: You’ll pay a $60 deductible per and no more than 15% of the cost of each presription drug.There is no cost for catastrophic coverage. For catastrophic coverage, your cost will be $2.40 for generics and $6.00 for brand-name drugs or 5% of the cost, whichever is greater.
If your income is higher than the requirement, you may still qualify for some benefits if you’re still working, supporting other family members in your household or live in Hawaii or Alaska.
If you think you qualify but don’t get the Extra Help benefit automatically, fill out an application from the Social Security Administration website or call 1800-772-1213 to apply by phone. You may also visit the local office of the Social Security Administration. The SSA will review your application and inform you whether you qualify. If you are turned down, you have the right to appeal.