Extra Help program for people on Medicare

Program benefits

A little extra help can go a long way

Also known as the Low-Income Subsidy, the Extra Help program is run by the
Social Security Administration and designed to help people on Medicare drug plans
pay for the monthly premiums, annual deductibles, and co-pays related to their
prescription medications.

While the program may not cover your out-of-pocket costs entirely, enrolling in the
program can significantly reduce what you pay for your medications.

If you’re a PAN grantee…

While your PAN grant covers the out-of-pocket medication costs for a specific diagnosis, Extra Help covers prescription medications for any condition. The Extra Help program can dramatically reduce your out-of-pocket costs, especially if you take multiple medications.

There are two levels of coverage:

Full Extra Help program

Full Extra Help supports people who are on Medicare and also qualify for their state’s
Medicaid program. Full Extra Help covers almost all costs. Most people eligible for full
coverage are automatically enrolled.

People eligible for Full Extra Help have less than $17,388 in individual annual income ($1,449 per month) or less than $23,517 in annual income as a couple ($1,960).

FULL EXTRA HELP BENEFITS*

• No monthly premium
• No annual deductible
• Co-pay is no more than $9.20
• No catastrophic co-pay for drugs

Partial Extra Help program

Partial Extra Help supports people who are on Medicare. If you have less than $19,320 in
annual income as an individual ($1,610 per month) or $26,130 as a couple ($2,178 per month), you may be eligible.

Please note: Most PAN grantees may only be eligible for Partial Help. People eligible for full coverage are almost always automatically enrolled.

PARTIAL EXTRA HELP BENEFITS*

• No monthly premium or premium based on a sliding scale
• $92 annual deductible
• Co-pay for the plan’s formulary drugs is 15% or the plan’s co-pay, whichever is less
• Catastrophic co-pay is no more than 5% of the drug cost.

Extra Help cost savings comparison

*2021 numbers
** Assumes drug falls into the 15% co-pay category

Find out if you qualify

You might be eligible if you have an annual income under $20,000 ( $1,700 per month)
and have less than $15,000 in assets. However, there are some exceptions.

Your assets may include bank accounts, savings bonds, mutual funds, Individual Retirement Accounts (IRAs), and any other cash at home or anywhere else. Include the things you own by yourself, with your spouse, or with someone else. Do not count your home, vehicles, personal possessions, life insurance, burial plots, irrevocable burial contracts, or back payments from Social Security or SSI.

Find out if you might be eligible for benefits below.

DISCLAIMER: This quiz does not replace the official enrollment process and uses Partial Extra Help numbers to qualify the results. Those that may be eligible for Full Extra Help will need to contact their State Health Insurance Program (SHIP) Center. Eligibility does not guarantee enrollment into the program.

How to apply

Applying for either program will require you to gather a variety of financial
documents and take some time, but application help is free.

What you need

When you fill out the application for the Extra Help program, the Social Security
Administration will request information about your income and resources, as well as
for the income and resources of your spouse if you are married and living together.

Here is an example of the questions they will ask. You can start the online application
process, save your work, and finish it another time. Family members, caregivers, and
other third parties can help you fill out the Extra Help application.

To answer these questions you’ll have to collect many documents and consider what
things you own alone, with your spouse, or with someone else.

While this may be overwhelming, the program helps you save a lot of money.
We’ve included a helpful checklist that you can use, print out, or email to yourself
below to help you get organized.

When you can apply

You can apply to the Extra Help program once each year, at any time.

Where to apply

If you want to apply directly…

Contact the Social Security Administration who operates the Extra Help program.
Call 1-800-772-1213 (TTY 1-800-325-0778) or visit their website.

If you need help with your application…

State Health Insurance Assistance Programs (SHIPs) provide free help to people with
Medicare and their families, including help with applying to the Extra Help program.
You can call toll-free 877-839-2675 or visit their website.

After applying

You won’t be asked for proof to support the information you provide in your Extra Help
program application. However, the information will be compared with data from other
government agencies to make sure the numbers match. After you apply, the Social
Security Administration will review your application and will send you a letter in six
weeks to let you know if you qualify for Extra Help.

How to stay enrolled

You have to continue to meet eligibility requirements to stay enrolled in the Extra Help
program each year. Here’s an overview of what will happen.