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What is "Extra Help" and how could it save you money on prescriptions?


Man at pharmacy

Many of you are eligible for Extra Help and may not even know it. For this Blog we are going to talk about Extra Help and what it provides to you as a Medicare Beneficiary.


Who is eligible for Extra Help?

You automatically qualify for Extra Help if you have:

  • Both Medicare and Medicaid

  • Help from Medicaid paying your Medicare Part B premium

  • You have both Medicare and Supplemental Security Income (SSI)


What will Extra Help do for you, the Beneficiary?

  • Extra Help will lower your monthly drug co-pays considerably and, in some instances, pay 100% of your drug copays. For 2024 you should pay no more than $4.50 for generic drugs and $11.20 for brand-name drugs.

  • Your Medicare Part D drug premium is usually $0 monthly and you will have no drug deductibles.

  • Extra Help is worth about $5,500 per year in savings.


When can I apply for Extra Help?

  • You can apply anytime, there is no Annual Enrollment Period or Special Enrollment Period.

  • The best time is right after you receive your Medicare card.


Where do I apply for Extra Help?

  • Apply through your local Medicaid Office or through Medicare

  • An agent/broker that helps with Medicaid and Extra Help

  • A Medicaid Assistance Company


Perfiniti Tip

Our sister company The WellFund will help you apply for Extra Help at no charge to you. Please call (855) 365-9300 or visit https://www.thewellfund.org/contact


How do I qualify for Extra Help?

Qualifying for Extra Help is state specific. The qualifications for Indiana residents is below. Contact Perfiniti for other states.


You may be eligible depending on your income and the value of things you own (2024):



Monthly Income

Assets

Qualified Medicare Beneficiary

Single

$1,903

$9,430


Couples

$2,575

$13,630

Specified Low Income Beneficiary

Single

$2,154

$9,430


Couples

$2,916

$14,130

Qualified Individual

Single

$2,342

$9,430


Couples

$3,172

$14,130

Assets include resources such as checking and savings accounts, certificates of deposit, cash value of life insurance, stocks, and bonds. Some things you own do not count towards your asset limit, such as your home and furnishings, your car, burial plots, and at least $1,500 in life insurance. Annuitized retirement savings may not be included under certain circumstances.


Approval for any of these programs makes you automatically eligible for Extra Help.

These limits are guidelines. The only way to know for sure if you are eligible is to apply.


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