Qualifications to Receive Extra Help With Medicare

The elderly and disabled in the United States are qualified for Medicare, a comprehensive health insurance program. Medicare Part D offers prescription drug coverage. Some individuals with limited incomes often have difficulty meeting some of the costs associated with Part D. Extra Help, an assistance program administered by the Social Security Administration, is a popular program that saves enrollees up to $3,900 per year.

Medicare-Eligible

• Anyone who is enrolled in Medicare is eligible to apply for Extra Help. This includes those who are Medicare-eligible, such as those who are 65 years of age and older, disabled, or diagnosed with end-stage renal disease or amyotrophic lateral sclerosis.

Must Have Part D

• Part D, Medicare's prescription drug program, is required in order to receive the Extra Help benefit. If an enrollee is not already in a Part D plan, then Medicare will enroll him in a plan automatically. The enrollee will be sent a green letter with information on the plan that states when coverage will begin.

Must Meet Income Guidelines

• Full Extra Help offers the most help toward Part D costs. To qualify, you must either have Medicaid or income below certain levels. Monthly income should have been $1,218 for singles and $1,639 for married couples in 2010. Partial Extra Help offers less help, but has more lenient income guidelines. In 2010, single people with a monthly income between $1,218 and $1,354 and married couples with monthly incomes between $1639 and $1,822 may be qualified.

Must Meet Asset Guidelines

• To qualify for Full Extra Help, assets should have been less than $8,100 for a single person and $12,910 for a married couple in 2010. Partial Extra Help asset limits were set at $12,510 (singles) or $25,010 (married couples) in 2010.

Automatic Enrollment

• Some people who are enrolled in other benefit programs are automatically enrolled into Extra Help. This includes those in Medicaid, Supplemental Security Income (SSI) or a Medicare Savings Program (MSP). MSPs are state-administered programs and so eligibility information is different nationwide, but in many states, there are more income disregards (such as medical expenses) that can be used to become eligible for an MSP but that do not apply to Extra Help. This could be a way to get into the Extra Help program if the beneficiary is slightly over the Extra Help income limit.

Best Available Evidence

• If beneficiaries know they are qualified for Extra Help but the application has not cleared the system yet, they can show the pharmacist any proof that they are qualified, and the pharmacist may not charge them more than the Extra Help co-payments. This includes any proof that they have Medicaid, or a notice from Social Security stating they are qualified.