Extra Help

If you have limited income and assets, you may qualify for Extra Help with the costs of your prescription drugs. The Social Security Administration (SSA) and Medicare are working together to give you this Extra Help. Extra Help is also called the Part D Low-Income Subsidy, or LIS.

Most people who qualify for Extra Help will pay:

  • No premiums,
  • No deductibles, and
  • No more than $6.60 in 2013 ($6.35 in 2014) for each drug their plan covers.

The amount of Extra Help you get depends on your income and resources.  If you qualify for this Extra Help, you can join a Medicare drug plan at any time. You will not have to pay a penalty, even if you enroll late.

IMPORTANT: People who receive Extra Help can change plans at any time – as often as once per month.

Do I qualify for Extra Help with costs?

There are different levels of Extra Help available, depending on your income and assets. People with a lower income and fewer assets get more help with their Medicare drug plan costs.

Level 1  You may qualify for Extra Help in 2013 if

your yearly income is less than this amount– AND the amount of resources you own does not exceed
$11,490 for an individual or $15,510 for a couple $8,580 for an individual or $13,620 for a couple

Level 2  You may qualify for Extra Help in 2013 if

your yearly income is less than this amount– AND the amount of resources you own does not exceed
$15,512 for an individual or $20,939 for a couple $8,580 for an individual or $13,620 for a couple

Level 3  You may qualify for Extra Help in 2013 if

your yearly income is less than this amount– AND the amount of resources you own does not exceed
$17,235 for an individual or $23,265 for a couple $13,300 for an individual or $26,580 for a couple

The resource amount includes $1,500 in savings that you can use as a burial fund. Couples can have $3,000 for the burial savings.

You may not qualify for Extra Help with costs if your income or assets are over these limits.

What if I don’t qualify for Extra Help?

There are special circumstances that let you have a higher income or more resources and still qualify. For example, if you work, if you support other family members who live with you, or if you live in Hawaii or Alaska, you may qualify even if your income is higher than these limits. There are also other programs that might be able to help you with your medical costs. BenefitsCheckUp can help you find out if you are likely to qualify for Extra Help or for help from other programs.

How much will I pay in 2013 if I get Extra Help?

Level 1
PremiumNone
DeductibleNone
For drugs, you would pay: $1.15 copay for generic drugs on your plan's drug list
$3.50 copay for brand name drugs on your plan's drug list
If your total drug costs go over $6,733.75 for the year, you pay no copay for drugs on your plan's drug list
Level 2
Premium: None
Deductible: None
For drugs, you would pay: $2.65 copay for generic drugs on your plan's drug list
$6.60 copay for brand name drugs on your plan’s drug list
If your total drug costs go over
$6,733.75 for the year, you pay no copay for drugs on your plan’s drug list
Level 3
Premium: Sliding Scale
Deductible: $66
For drugs, you would pay: 15% up to $6,733.75
If your total drug costs go over $6,733.75 for the year, you pay:
$2.65 copay generic drugs on your plan’s drug list
$6.60 copay for brand name drugs on your plan’s drug list

How do I apply for Extra Help?

Apply online using BenefitsCheckUp. After you apply, Social Security and Medicare will send you a letter to let you know if you qualify.

You can also request a form from the Social Security Administration. Look online to find an office near you or call 1-800-772-1213 (TYY 1-800-325-0778). It's important to use an original copy of the application and not a photocopy, because machines that read the ink and pencil marks on the page process these forms.

  • This field is for validation purposes and should be left unchanged.