Having trouble affording your prescriptions? | Medicare Extra Help

Anyone with Medicare qualifies for Prescription Drug Coverage (Part D). Depending on your income and resources you may also qualify for Extra Help with Prescriptions. The Extra Help program is estimated to save folks who have Medicare about $5000 a year in premiums, annual deductibles, and prescription copays. This program is applied for through Social Security. Those who qualify for Medicaid or Medicare Savings Programs are automatically qualified for Extra Help with Prescriptions (also known as Low Income Subsidy for Prescription Drugs LIS).

Eligibility for Extra Help is determined according to your level of Income and Resources. For instance, if your income is below 150% of the Federal Poverty Line, and your individual resources are below $14,790 in 2021; you probably qualify for what is known as Partial Extra Help. With Partial Extra Help, you may have no more than a $94 drug deductible and pay 15% of the negotiated retail cost of your medications, or your plan co-pay, whichever is less. If your income is below 135% of the Federal Poverty Line; and your individual resources are below $9,470, you would probably qualify for full Extra Help. With Full Extra Help, you would have a $0 drug deductible; and in 2021 your copays would be no more than $3.70 for generic or $9.20 for name brand medications. Your Prescription Drug Plan premiums are also subsidized according to your level of Extra Help.

Beyond helping with prescription costs, Extra Help also makes an SEP (Special Election Period) available once for each of the first 3 quarters of the year when you can change your Medicare Advantage or Prescription Drug Plan. For those who might have an LEP (Late Enrollment Penalty) incurred for late enrollment in drug coverage; qualifying for Extra Help at any level negates the penalty.

Patient Assistance Programs are usually offered through drug manufacturers and vary in their eligibility guidelines and benefits offered. If you do not qualify for Extra Help with Prescriptions because your income and resources are too high; Patient Assistance Programs have much more generous eligibility guidelines ranging from 250%-600% depending on the medication and the manufacturer’s program guidelines. These programs can enable you to receive free medication that would otherwise be unaffordable. There are companies that charge fees for locating and administrating these programs. We never charge any fees for helping our clients with Patient Assistance!