Many older adults and people with disabilities on Medicare struggle with prescription drug costs, especially if they take expensive medications or hit the “donut hole” at some point during the year. The good news is that help is available with Medicare prescription drug costs. Individuals can apply for this help at any time during the year, and the application generally does not require sending in any documentation to prove one’s information.
To qualify for Extra Help with Medicare Prescription Drug Costs, individuals must meet income and resource guidelines that can change each year. In 2016, the income limit is $1,485/month and the resources limit is $13,640 for a single person. For married couples, the income limit is $2,003/month and the resource limit is $27,250. Resources do not include someone’s primary residence, motor vehicles, life insurance, burial spaces or plots, or some pre-paid burial accounts. Since not all income or resources count, people are encouraged to apply even if they appear to be over these limits.
The Social Security Administration handles the applications for Extra Help. Individuals can apply online (ssa.gov/prescriptionhelp), by phone (800-772-1213), or by mail (must be an original paper application and not a photocopy). As mentioned earlier, people are not required to send in documentation with their application. If Social Security needs any additional information, they will contact the applicant to request this. All applicants will get a written notice telling them whether they qualify for Extra Help, how much help they will get, and when the Extra Help starts. Those who are denied Extra Help can appeal.
Please note: Medicare beneficiaries who get any help from Medicaid (even if it is just the help with the Medicare Part B premium) automatically qualify for Extra Help and do not need to apply. Medicare sends out letters on purple colored paper to notify these individuals about their Extra Help.
There are two levels of Extra Help: full help and partial help. Those with the lowest income and resources qualify for full help, as do people on both Medicare and Medicaid. Others qualify for partial help. Extra Help lowers or eliminates the person’s Part D premium and annual deductible, limits their co-pays at the pharmacy, and eliminates the donut hole. Extra Help can save people thousands of dollars a year in prescription drug costs.
Anyone who needs help applying for Extra Help or who wants more information about Extra Help is encouraged to call APPRISE at (800) 783-7067. Individuals denied Extra Help can call the Pennsylvania Health Law Project at (800) 274-3258 for help.
This article was written by the PA Health Law Project, which provides free legal help to low-income seniors. Call PHLP’s Helpline at (800) 274-3258 or visit phlp.org.